A casenote review identified 18 patients with carcinoma of the oesophagus and gastric cardia who underwent transthoracic oesophagectomy after instrumental perforation. Oesophagectomy was performed within 48 h in ten patients (early surgery group) and after a median delay of 22 (range 5–48) days in eight patients (delayed surgery group). All patients underwent resection via left thoracolaparotomy with immediate intrathoracic anastomosis using the stomach in 17 of 18 patients. There were no anastomotic leaks. Significant postoperative complications occurred in five of ten of the early group with two in-hospital deaths and a mean survival of 551 days. Six of eight patients in the delayed group developed postoperative complications with two in-hospital deaths and a mean survival of 297 days. Transthoracic resection with immediate intrathoracic anastomosis can be performed without anastomotic leakage but there is high associated respiratory morbidity. The timing of oesophagectomy has little effect on hospital morbidity or mortality rates but early surgery is associated with better long-term survival.