Carcinoma of the hypopharynx has a great tendency to metastasize to the neck. In addition it often metastasizes to the upper retropharyngeal lymph nodes (Rouviere's lymph nodes) and to the paratracheal lymph nodes. In this study, in order to determine the pattern of lymph node metastasis. 112 patients with carcinoma of the hypopharynx who had undergone bilateral radical neck dissection, bilateral paratracheal dissection, bilateral dissection of retropharyngeal nodes as an initial treatment between January 1982 and June 1997 in the Kurume University Hospital. were retrospectively reviewed in detail. Special attention was paid to retropharyngeal nodes and paratracheal lymph nodes. In NO cases neck metastases were seen in more than one quarter of the patients. Metastasis to retropharyngeal lymph nodes and toi the paratracheal lymph nodes was seen in 5.4% and 12.5% of the patients, respectively. The frequency of metastasis to paratracheal lymph nodes had a significantly close relation- ship with that to, the upper and lower jugular lymph nodes. The frequency of metastasis to retropharyngeal lymph nodes also had signficantly close relationship with that to paratracheal lymph nodes, while having no relationship with that to other neck lymph nodes. These results suggest the following: 1) In patients with T1 or T2 PS type carcinoma of the hypopharynx, in which the lesion is confined unilaterally and is presumed to have been successfully treated by laser surgery prior to radiotherapy, unilateral neck dissection in alone will be sufficient. In all the other patients with carcinoma of the hypopharynx bilateral neck dissection must be performed. 2) In all patients retropharyngeal lymph nodes and paratracheal Iymph nodes should be dissected as much as possible and postoperative irradiation to both areas will be necessary.