This is a retrospective paper from Zagreb of 61 patients with a clinically T1-T3 N0 squamous cell carcinoma undergoing primary surgical treatment. All patients had a level I-IIII/IV elective neck dissection. Those who had adverse histological features, including extracapsular spread, underwent postoperative radiotherapy. Twenty-six of the 61 patients exhibited a false negative neck and extracapsular spread was found in 14 (22.9%). They found the presence of extracapsular spread tripled the chance of local recurrence and an increased chance of regional relapse by 14-fold. In addition, the time to recurrence was significantly shorter in the extracapsular spread group than in patients with metastasise confined to the lymph nodes and in node negative patients. They suggested that extracapsular spread, they acknowledged, and the increase in local recurrence could not be attributed to the presence of extracapsular spread in isolation. They also found that the involvement of the lower levels of extracapsular spread did not influence the final outcome.