Description:

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: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EFDC60F3-98DE-1623-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EFDC60F3-98DE-1623-E034-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/16/15
Uploaded on:

June 16, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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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.

Header
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
Pneumonia
Pulmonary embolism
Myocardial infarction
Stroke
DVT
Bowel obstruction requiring surgery
Abscess (intra-abdominal)
Anastomotic leak
Fistula
Wound infection
Dehiscence
Evisceration
Urinary infection
Regional implants
specify site
Tumor Configuration or Features
Lymphatic (small vessel)
Venous (large vessel)
Perineural
Intratumoral/peritumoral lymphocytic response
Description of tumor border configuration
None identified
Adenoma (s)
Chronic ulcerative proctocolitis
Crohn's disease
Dysplasia
Signature

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