The records of 37 patients with histopathologically confirmed adenoid cystic carcinoma, who presented to McGill University's Department of Otolaryngology between 1956 and 1990, were reviewed to determine factors influencing local failure, distant metastases, and survival. Of the 37 cases, 12 developed local recurrences. Local failure was seen an average of 3.5 years following initial treatment, 62% of which were seen prior to 2 years. No statistically significant advantage was found for the use of postoperative radiotherapy in the prevention of local recurrences. Thirteen cases presented with or subsequently developed distant metastases. The mean interval between initial treatment and the appearance of distant disease was 8.1 years. A comparison of survival in patients with negative versus positive surgical margins was carried out. Survival at 15 years with negative margins remained 100%, while with positive margins, only 35% survived. Disease-free survival with negative and positive margins at 10 years was 80% and 31.1%, respectively. The effect of positive margins on survival was statistically significant with a p values between .01 and .001. The aim of this study was to demonstrate the importance of negative surgical margins with regard to survival. The results suggest that negative margins at initial resection significantly improve long-term disease-free survival.