A retrospective study of 61 patients with histologically confirmed lymph node metastases was undertaken to evaluate the prognostic significance of extranodal spread (ENS) of metastases on the patterns of treatment failure and survival. ENS was present in 28 (46%) of the 61 patients and it was significantly associated with N stage. T stage, clinical stage, number of positive nodes, level of metastases, mode of treatment, and histological differentiation, however, did not influence the incidence of ENS. The 5-year disease-specific survival rate was 57%. The values for patients with and without ENS were 40% and 72%, respectively, which were statistically significant. The univariate analysis showed that the presence of ENS was a significant predictor of patient survival (P = 0.008). The number and level of positive nodes and postoperative radiotherapy had no prognostic importance. ENS, however, was also associated with an increased risk of distant metastases.