Abstract: Objective :To study the ideal method for surgical treatment of perforation inesophageal carcinoma and the characteristics of perioperative treatment. Methods :Thirty-six caseswith perforation in esophageal carcinoma were treated surgically in this series, among which 14 oc-curred at the right lung, 17 in the mediastinum and 5 in trachea. Open thoracic surgery was performedin 34 cases, in which the method of right thoracic approach with 3 incisions was applied in 16 cases,and staging-operation in 15. Of the 34 cases, retrosternal substitution of esophagus with stomach orcolon was conducted in 26 cases. Results :Surgery was successful in 31 cases and intraoperative deathoccurred in 3 cases. The postoperative follow- up study was from 3 to 72 months, among which 15 casesalive in 7 to12 months, 2 in 24 months, and 1 cases 72 months. The results can be considerd satisfac-tory. Conclusions :The therapeutic result of surgical treatment of perforation in esophageal carcinoma ismarkedly superior to that of conventional conservative treatment. The authors suggest that surgical in-tervention without delay should be undertaken for patients with perforation in carcinoma of the esopha-gus using the method of right thoracic approach with 3 incisions (retrosternal replacement of esophaguswith stomach or colon) and the staging operation is preferable.