A retrospective review of 18 patients treated for Boerhaave's syndrome in our center from 1954 to 2006 was undertaken. The patients were divided into two groups: group 1, the time delayed before treatment was less than 24 hours; group 2, the time delayed was more than 24 hours. The time interval between perforation and the onset of treatment in group 2 was from 50 hours to 30 days. Roentgenograms of the chest and esophagogram with a water-soluble contrast medium are able to reveal the perforation in most cases, and thoracentesis or thoracic drainage after swallow methylene blue may provide help as well. Surgical intervention was adopted in all three patients in group 1 and 12 in group 2, and conservative intervention in three in group 2. In group 1, two patients recovered uneventfully, the other one developed a postoperative respiratory infection, and he recovered after the infection was controlled. The mortality in group 2 was 33.3% (5/15), and the mortality in patients with conservative intervention was 100% (3/3). Five complications occurred after surgical intervention in group 2, including four fistulae and one incision infection. In conclusion, it may be appropriate to manage patients aggressively with primary repair and adequate mediastinal and pleural drainage when patients present late. Because of the syndrome's initial severity and a tendency to postoperative complications, patients should be closely monitored, and correct antibiotic therapy and adequate nutrition are very important in treatment.

OBJEcrI~ To determine the, ideal methact of s~gicat: preoperative treab rne~t, for perforation wi~ eso~ageal carcino.ma~. 36 cases of perforation with esophageal carcinoma were. treated, surgically in this series. Perforations occurred into the right lung in 14 cases, the mediastinum in 17 cases ar~ trachea in 5 cases. Open thoracic surgery was ~ in 34 cases, in which" the right thoracic approach, using a 3-incision method was appliL-=d in 16 cases, and oper~ation by stages in 15 cases. Of the 34 cases, retrosternal, substitution, of the esophagus with stomach or colon was performed in 26 cases. I~F~L't~ Surge~ was successful in 31 cases and operative death occurred in 3 cases. The postoperative follow up study was from 3-72 months. Of these cases 15 were alive at 7-12 months, 2 at 24 months, and 1 at 72 months. The results can be considered satisfactory. CONCLUSION The -therapeutic results of surgical treatment of perforation • with esophageal carcinoma were markedly superior to that of conventional, oonservati~e Izeatment. The authors suggest that surgical inte~entio~ witheL~t~ de~ay should be undertaken for patients having a perforation with carcinoma o,f ~e esophagus. A right thoracic approach with a 3-incision method (retros'[ernat replacement of esophagus with stomach or colon) or operation by stages is preferable.