Abstract Background Accurate staging of locally advanced oesophageal cancer plays a pivotal role in treatment planning and prognostic counselling for the patients. Clinical staging employs various imaging modalities to guide treatment decisions and predict outcomes. This study aimed to compare clinical staging (post neoadjuvant chemotherapy) with the final histopathological staging in patients with locally advanced oesophageal adenocarcinoma undergoing oesophagectomy at Belfast Health and Social Care Trust. Methods A retrospective analysis was conducted on a cohort of 81 patients diagnosed with locally advanced oesophageal adenocarcinoma who underwent neo-adjuvant chemotherapy followed by oesophagectomy at Belfast Trust between March 2020 and March 2022. Patients with squamous cell carcinoma, those who proceeded directly to surgery and those treated with salvage oesophagectomy following previous radical chemo-radiotherapy were excluded from the study to minimise heterogeneity. Two independent radiologists reviewed the restaging PETCT scans and validated the clinical staging. The post neoadjuvant clinical staging was subsequently compared to the final histopathological staging obtained from surgical resection specimens. Results Among the 81 patients included in this study, a significant proportion of patients were upstaged (53%) or downstaged (31%). The combined T&N staging accuracy was observed in only 13 patients (16%). 21 patients (26.3%) had their T staging downstaged on final assessments. Nodal staging discrepancies were observed in 35 cases (43.2%) upon final histopathological assessment. These isolated nodal discrepancies primarily involved nodal upstaging, with 14 patients upstaged from N0 to N1 and 13 patients upstaged from N0 to N2. Conclusions The accuracy of clinical staging for oesophageal adenocarcinoma remains poor. Our study revealed notable discrepancies in nodal staging between clinical and final histopathological staging. Approximately 43.2% of patients had isolated nodal discrepancies, primarily involving nodal upstaging. These findings emphasize the challenges in accurately assessing nodal involvement and highlight the need for improved staging methods to guide optimal treatment for locally advanced oesophageal adenocarcinoma. The topic of whether the routine use of EUS is justified for evaluating regional lymphnodes and enhancing staging remains a subject of debate, notwithstanding the limitations and challenges inherent to EUS.