E5202 Surgery Form NCT00217737 Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/16/15 6/16/15 -
Uploaded on:

June 16, 2015

To request one please log in.
License :
Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

E5202 Surgery Form NCT00217737

INSTRUCTIONS: Complete this form within one week of registration. Submit original to the ECOG Coordinating Center. Keep a copy for your files. NOTE: Also submit operative and pathology reports.

Report period
Are data amended (If yes, please circle amended items in red.)
Patient demographics
Surgery assessment
Most Extensive Primary Surgery
Proximal margin
Distal margin
Circumferential margin (Radial)
Mesenteric margin
Other surgery related to tumor
Adjacent organs involved and resected
Pulmonary embolism
Myocardial infarction
Bowel obstruction requiring surgery
Abscess (intra-abdominal)
Anastomotic leak
Wound infection
Urinary infection
Regional implants
specify site
Tumor Configuration or Features
Lymphatic (small vessel)
Venous (large vessel)
Intratumoral/peritumoral lymphocytic response
Description of tumor border configuration
None identified
Adenoma (s)
Chronic ulcerative proctocolitis
Crohn's disease

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial