E3201 Surgery Form NCT00068692 Comparison of Adjuvant Chemotherapy Regimens in Treating Patients With Stage II or Stage III Rectal Cancer Who Are Receiving Radiation Therapy and Fluorouracil Before or After Surgery Source Form: NCI FormBuilder:


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  1. 8/27/12
  2. 1/9/15
  3. 6/16/15
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June 16, 2015

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E3201 Surgery Form NCT00068692

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  1. StudyEvent: E3201 Surgery Form
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Time Period
Are data amended? (If yes, please circle amended items in red)
Surgery assessment
Patient Group
Planned Surgery Type
Rectal tumor status
Did patient undergo surgical resection?
Do surgery results qualify patient for further protocol therapy?
Primary surgery type
Was sphincter preserved?
Was there bowel perforation?
Was there bowel obstruction?
Was there tumor spillage?
Were all lymph nodes suggestive of disease removed?
Was a complete resection done?
Was completion of an en bloc resection of the primary tumor documented?
Did the primary tumor adhere to or invade an adjacent organ?
Have the radial margins been documented as grossly free of disease?
Have the radial margins been documented as histologically free of disease?
Type of anastomosis
Was anastomosis stapled?
Was a pouch created?
Tumor Statging
Pathologic T stage
Pathologic N Stage
Pathologic M Stage
Ccrr Module For E3201 Surgery Form

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