Imai T, et al. - Experts clarified risk factors for lymph node (LN) metastasis in patients with hypopharyngeal cancer (a head and neck cancer with a poor prognosis) in order to better assess surgical treatment strategies for these patients. There were 93 superficial hypopharyngeal cancer patients with 109 histopathologically examined lesions treated by endoscopic resection between January 2007 and December 2017 included in this retrospective study. Patient characteristics between LN-positive and LN-negative cases demonstrated no significant differences, apart from significantly larger tumor thickness seen in LN-positive cases. A powerful predictor of LN metastasis may be high budding grade, and a significant risk factor for LN metastasis of superficial hypopharyngeal cancer is tumor thickness ≥1000 μm, demonstrated in the findings for the first time.