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Background and Objectives This study aimed to improve the comprehensive understanding of the entire management process of salivary duct carcinoma (SDC) by analyzing appropriate preoperative diagnostic and therapeutic strategies for better outcomes in patients with SDC. Subjects and Method The medical records of 27 patients who received primary treatment for SDC from 2011 to 2022 were retrospectively reviewed. The demographic data, preoperative diagnosis, treatment and outcomes, and patterns of treatment failure were analyzed. Results The mean age was 60 years (range: 19-83), with males being predominant (70.4%). Twenty-three patients (85.2%) presented with a painless neck mass. The preoperative determination rate of SDC by fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) was 0% and 28.6%, respectively (p=0.028). Twenty patients (74.1%) were diagnosed as stage III or IV at the time of diagnosis. All patients received radical resection of the primary tumor with or without lymph node dissection. Twenty-four patients (88.9%) received postoperative radiation therapy. Treatment results from the 24-months of median follow-up period were as follows: overall treatment failure was observed in nine patients (33.3%); regional failures but involving no local failures were observed in two (7.4%), and distant failures were observed in eight (29.6%). The 3-year overall and disease-free survival rates were 79.8% and 61.9%, respectively. Conclusion Most patients with SDC presents with an asymptomatic neck mass, despite its advanced stage at the time of diagnosis. CNB shows more superior diagnostic performance than FNAC, but its preoperative diagnosis is still challenging. Distant metastasis is the most common cause of treatment failure and death. Based on current findings, further clinical trials should be introduced to enhance preoperative diagnosis and distant control of SDC.