{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:04:17Z","timestamp":1790661857218,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anastomotic leakage (AL) after esophagectomy is a serious complication for which early physiological signals remain limited. We conducted a hypothesis-generating analysis of whether routinely reported electrocardiographic QRS measurements were associated with AL during the perioperative period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort included 292 of 1,441 patients undergoing esophagectomy who had an index 12-lead electrocardiogram (ECG) from day \u22121 through postoperative day 1. ECG acquisition followed routine clinical practice rather than a study protocol. QRS duration and frontal-plane QRS axis were retained after descriptive screening of the continuous ECG measurements available in the analytic extract. They were entered into a two-variable logistic model, followed by a sensitivity model additionally adjusting for seven clinical characteristics. Timing-stratified associations and same-cohort model discrimination were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      AL occurred in 29 of 292 patients (9.9%). Patients with AL had a shorter QRS duration (median, 86 vs. 92\u2005ms;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.016) and a more leftward QRS axis (4 degrees vs. 27 degrees;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006). In the two-variable model, standardized odds ratios (ORs) were 0.378 (95% CI, 0.178-0.801) for QRS duration and 0.501 (0.323-0.779) for QRS axis. In the sensitivity model, the corresponding ORs were 0.359 (0.170-0.761) and 0.486 (0.299-0.789). The QRS-axis association was stronger preoperatively, whereas the QRS-duration association was stronger from day 0 through postoperative day 1. Median repeated-cross-validation AUCs were 0.702 for the ECG model, 0.559 for the clinical reference model, and 0.690 for the combined model; bootstrap confidence intervals for both AUC differences versus the clinical reference included zero.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Shorter QRS duration and a more leftward frontal-plane QRS axis were associated with AL after esophagectomy. These QRS measurements are potential perioperative signals that require prospective validation rather than established predictors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1942699","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:50:53Z","timestamp":1790661053000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Shorter perioperative QRS duration and a leftward frontal-plane QRS axis are associated with anastomotic leakage after esophagectomy: a hypothesis-generating study"],"prefix":"10.3389","volume":"13","author":[{"given":"Mengke","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youjia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Handan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weizhuo","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendi","family":"Fei","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haotian","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"He","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2383","DOI":"10.1016\/S0140-6736(17)31462-9","article-title":"Oesophageal cancer","volume":"390","author":"Lagergren","year":"2017","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1016\/S2468-1253(25)00207-9","article-title":"Thoracoscopic versus open oesophagectomy for patients with oesophageal cancer (JCOG1409 MONET): a multicentre, open-label, randomised, controlled, phase 3, non-inferiority trial","volume":"10","author":"Takeuchi","year":"2025","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"doae086","DOI":"10.1093\/dote\/doae086","article-title":"Minimally invasive vs open vs hybrid esophagectomy for esophageal cancer: a systematic review and network meta-analysis","volume":"37","author":"Patton","year":"2024","journal-title":"Dis Esophagus"},{"key":"B5","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/SLA.0000000000002611","article-title":"Benchmarking complications associated with esophagectomy","volume":"269","author":"Low","year":"2019","journal-title":"Ann Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"107983","DOI":"10.1016\/j.ejso.2024.107983","article-title":"Oesophago-gastric anastomotic audit (OGAA) collaborative. 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