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Updated: Oct 15, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Shorter perioperative QRS duration and a leftward frontal-plane QRS axis are associated with anastomotic leakage
Mengke Ma1, Youjia Zhu1, Handan Lin1
1Department of Critical Care Medicine and Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
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.
Methods:
This single-center retrospective cohort included 292 of 1,441 patients undergoing esophagectomy who had an index 12-lead electrocardiogram (ECG) from day -1 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.
Results:
AL occurred in 29 of 292 patients (9.9%). Patients with AL had a shorter QRS duration (median, 86 vs. 92 ms; P = 0.016) and a more leftward QRS axis (4 degrees vs. 27 degrees; P = 0.006). 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.
Conclusion:
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.
