AT THE present time, the generally accepted management of perforation of the esophagus at the site of a malignant process consists in simple drainage of the mediastinum and administration of antibiotics, with gastrostomy or jejunostomy. If the patient survives, the neoplasm is extirpated at a later date. With this method, despite encouraging individual reports,1 the over-all mortality rate is still high, exceeding 60%.2 Unfortunately, these references fail to indicate the separate mortality rates for the malignant and the nonmalignant cases; it would be reasonable to suppose that the mortality in the former group is higher.
In view of the advances made in thoracic surgery and anesthesia and the wider application of antibiotics, it appeared to us that primary resection for carcinoma of the esophagus associated with perforation and mediastinitis merited consideration. A search of the literature fails to reveal any reports recommending this procedure. We are, therefore, presenting