Background Perforation of the oesophagus is one of the most dangerous types of gastrointestinal perforation, with a high morbidity and significant mortality. The relative rarity of oesophageal perforation excludes randomized multicentre studies of these cases. Treatment standards are based mainly on retrospective assessment and expert’s opinion. Aim The aim of this study was to compare the efficacy of oesophageal perforation with the use of surgical procedures, such as suturing, surgical drainage, resection, stenting or conservative treatment. Furthermore, the influence of other factors such as aetiology, location, the time elapsed from injury to initiation of the treatment, patient’s age and comorbidities on the final outcome was investigated. Materials and methodsA retrospective analysis included data of 91 patients treated for esophageal perforation in the Department of Thoracic Surgery Hospital, the John Paul II in Krakow between 1989 and 2009. For the statistical analysis the logistic regression method was used for each variable separately and combined. Results Significant prognostic factors were: patient’s age, type of perforation and initial ASA score. Patient sex, location of the perforation, time from perforation to initiation of the treatment and comorbid conditions, and postoperative oesophageal leak had no significant prognostic value. Resection of the oesophagus was associated with significantly higher mortality. The most common complication of the treatment was multi-organ dysfunction syndrome). Conclusions Elderly patients with spontaneous perforation and ASA 4 had significantly higher mortality. Therapeutic decisions regarding the choice of surgical or conservative treatment should take into account these prognostic factors. Resection of the oesophagus is associated with the highest percentage of treatment failures, so that indications for this treatment method should be made with particular caution. Postoperative oesophageal leak had no direct effect on outcomes. Multi-organ failure is a major cause of death.