목적: Despite being relatively rare and therefore not extensively documented, therapeutic neck dissection (ND) for cervical lymph node (LN) metastasis originating from distant primary sites is increasingly practiced and may contribute to improved survival rates. However, the optimal extent of ND remains unclear. The aim of our study was to determine whether upper neck levels can be safely excluded in ND for cervical LN metastasis originating from distant primary tumors. 방법:We conducted a retrospective analysis of patients who underwent ND for cervical LN metastases from remote primary tumors between 2015 and 2021. We assessed clinical characteristics, occult metastasis rates based on preoperative clinical LN status, postoperative pathologic LN localization, and patient survival rates. 결과:Assessing clinical characteristics and occult metastasis rates, we observed LN metastases predominantly at levels III and IV. Occult metastases occurred in 14 out of 25 patients, primarily at neck levels III and IV (55.0% and 50.0%, respectively). The five-year disease-specific survival rate for all patients was 44.3%. While no statistically significant impact of occult metastasis on prognosis was confirmed, an association between the postoperative LN ratio and poor prognosis was revealed. Conclusions: Our findings suggest that prophylactic NDs at levels I, II, and Va may not be essential for managing cervical LN metastases from remote primary malignancies. This could lead to a more tailored and less invasive therapeutic strategy. 결론:Our results recommend including levels III, IV, and VB in therapeutic NDs for cervical LN metastases from remote primaries, while suggesting that the upper ND might be omitted. However, larger prospective and comparative studies are required to confirm the optimal extent of surgery.