BACKGROUND: This study aimed to characterize the pattern of cervical lymph node spread and evaluate prognostic factors and outcomes of surgery and postoperative adjuvant therapy in primary parotid carcinoma (PPC). METHODS: We retrospectively enrolled 136 patients with PPC. The primary outcomes were disease-free survival (DFS) and overall survival (OS). We used Cox hazards models to assess variables influencing survival, and chi-square tests and logistic regression models to evaluate correlations between pN + and clinicopathological factors. RESULTS: Pathology-confirmed lymph node metastasis was detected in 60.0% and 84.1% of the patients with cT1-2 and cT3-4 tumors, respectively. The occult metastasis rate in cN0 was 55.2%. Level II metastasis was most common (93.2%), followed by level I (49.3%). Histological type, histologic grade, pT stage, and AJCC stage were significant risk factors for lymph node metastasis. One- and five-year OS were 86.0% and 49.3%, respectively (median, 60 months) and 71.6% and 34.8%, respectively, for DFS (median, 24 months). Surgery with CONCLUSION: Histological high grade and advanced T classification were associated with occult lymph node metastasis. Postoperative radiotherapy (RT)/radiochemotherapy (RCT), conferred significant survival benefits in PPC. Neck dissection in patients with cN0 cancer significantly improved DFS and should be performed on those with high-grade and/or advanced T-stage tumors.