Three-field lymphadenectomy was performed in 192 patients. R0 resection was obtained in 174 patients. Twenty-five percent (41 of 174) had cervical lymph node involvement resulting in a TNM change (stage IV) in 12%. Overall 5-year survival was 41.9%, being 80% for lymph node-negative patients (n = 52). Locoregional lymph node recurrence occurred in 5.2% of the patients (n = 9), distant metastasis in 28.5% (n = 49), and both locoregional lymph node recurrence and distant metastasis in 10% (n = 17). Patients with middle third squamous cell carcinoma had a 5-year survival of 27%. Cervical lymph node involvement in these patients should be classified as regional lymph node involvement (N1) and not as distant lymph node disease (M1b).