ID

11229

Description

USMCI 8214/Z6091: Surgical Data Form NCT01167725 Standard Therapy With or Without Surgery and Mitomycin C in Treating Patients With Advanced Limited Peritoneal Dissemination of Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=62067A0E-23F3-1D8C-E040-BB89AD435F13

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=62067A0E-23F3-1D8C-E040-BB89AD435F13

Keywords

Versions (3)
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/26/15 6/26/15 -
Uploaded on

June 26, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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USMCI 8214/Z6091: Surgical Data Form NCT01167725

English

No Instruction available.

1 forms  
  1. StudyEvent: USMCI 8214/Z6091: Surgical Data Form
    1. No Instruction available.
Patient demographics
Description

Patient demographics

Visit
Description

AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19712
UMLS 2011AA ObjectClass
C1515944
NCI Thesaurus ObjectClass-2
C25716
UMLS 2011AA ObjectClass-2
C0545082
Patient ID
Description

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Institution No.
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Assessment of surgery
Description

Assessment of surgery

Was surgery performed
Description

ProtocolSurgeryPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus ObjectClass-2
C42651
UMLS 2011AA ObjectClass-2
C0442711
Reason surgery not performed
Description

ProtocolSurgeryNotPerformedReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Description

ProtocolSurgeryNotPerformedSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Was attempted surgery completed
Description

SurgeryCompleteInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
Surgeon's First Initial
Description

SurgeonFirstInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C18071
UMLS 2011AA ObjectClass
C0582175
NCI Thesaurus Property
C40974
UMLS 2011AA Property
C1443235
Surgeon's Last Name
Description

SurgeonLastName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C18071
UMLS 2011AA ObjectClass
C0582175
NCI Thesaurus ValueDomain-2
C25551
UMLS 2011AA ValueDomain-2
C1517741
NCI Thesaurus Property
C40975
UMLS 2011AA Property
C1301584
Surgery Date
Description

Surgery Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1628561
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C15329
NCI Thesaurus Property
C25275
Surgery Duration
Description

Duration of Surgery

Data type

float

Alias
NCI Thesaurus ObjectClass
C15329
UMLS CUI-1
C0488629
NCI Thesaurus Property
C25275
NCI Thesaurus ValueDomain
C25330
Estimated blood loss
Description

BloodLossAmount

Data type

float

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus Property
C25559
UMLS 2011AA Property
C1517945
NCI Thesaurus ValueDomain
C25417
Total number of units PRBC
Description

PackedRedBloodCellTransfusionReceivedUnitCount

Data type

float

Alias
NCI Thesaurus ValueDomain
C44278
UMLS 2011AA ValueDomain
C0439148
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Thesaurus ValueDomain-2
C25463
UMLS 2011AA ValueDomain-2
C0750480
NCI Thesaurus ObjectClass
C15409
UMLS 2011AA ObjectClass
C0199962
Ascites drained
Description

AscitesDrainageInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C2885
UMLS 2011AA ObjectClass
C0003962
NCI Thesaurus Property
C50434
UMLS 2011AA Property
C0013103
Intraperitoneal heated chemotherapy administered
Description

IntraperitonealChemotherapyAdministeredInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass-2
C13352
UMLS 2011AA ObjectClass-2
C0442120
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Mitomycin dose
Description

MitomycinAgentAdministeredDose

Data type

float

Alias
NCI Thesaurus ObjectClass
C1708
UMLS 2011AA ObjectClass
C0450442
NCI Thesaurus ObjectClass-2
C663
UMLS 2011AA ObjectClass-2
C0026254
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
NCI Thesaurus ValueDomain-2
C1708
UMLS 2011AA ValueDomain-2
C0450442
Target inflow temperature (Degree Celsius)
Description

SurgicalProcedureTargetChemotherapyTemperatureValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C15632
UMLS 2011AA Property
C0392920
NCI Thesaurus Property-2
C25206
UMLS 2011AA Property-2
C0039476
NCI Thesaurus Property-3
C25702
UMLS 2011AA Property-3
C1521840
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Perfusate volume (L)
Description

SurgicalProcedurePerfusionVolumeValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C25335
UMLS 2011AA Property
C0449468
NCI Thesaurus Property-2
C15295
UMLS 2011AA Property-2
C0031001
Peritoneal Carcinomatosis Index
Description

Peritoneal Carcinomatosis Index

Anatomic region
Description

PeritonealCarcinomatosisInvolvementAnatomicSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
PCI at exploration
Description

PeritonealCarcinomatosisExploratorySurgeryInvolvementScore

Data type

float

Alias
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
NCI Thesaurus Property-2
C66747
UMLS 2011AA Property-2
C1880637
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
CT/Laparoscopic PCI
Description

PeritonealCarcinomatosisLaparoscopyInvolvementScore

Data type

float

Alias
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C25548
UMLS 2011AA Property-2
C1314939
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
PCI at completion
Description

PeritonealCarcinomatosisPostSurgicalProcedureInvolvementScore

Data type

float

Alias
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15329
UMLS 2011AA Property-2
C0543467
NCI Thesaurus Property-3
C25548
UMLS 2011AA Property-3
C1314939
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Total PCI Score (CT/Laparoscopic PCI)
Description

PeritonealCarcinomatosisLaparoscopyInvolvementTotalScore

Data type

float

Alias
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C25548
UMLS 2011AA Property-2
C1314939
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25338
UMLS 2011AA ValueDomain-2
C0449820
Total PCI Score (PCI at Exploration)
Description

PeritonealCarcinomatosisExploratorySurgeryInvolvementTotalScore

Data type

float

Alias
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
NCI Thesaurus Property-2
C66747
UMLS 2011AA Property-2
C1880637
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25338
UMLS 2011AA ValueDomain-2
C0449820
Total PCI Score (PCI at Completion)
Description

PeritonealCarcinomatosisPostSurgicalProcedureInvolvementTotalScore

Data type

float

Alias
NCI Thesaurus ObjectClass
C25313
UMLS 2011AA ObjectClass
C0442034
NCI Thesaurus ObjectClass-2
C3693
UMLS 2011AA ObjectClass-2
C0205699
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15329
UMLS 2011AA Property-2
C0543467
NCI Thesaurus Property-3
C25548
UMLS 2011AA Property-3
C1314939
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25338
UMLS 2011AA ValueDomain-2
C0449820
Reconstructions/diversions
Description

Reconstructions/diversions

Reconstructions/Diversions
Description

SurgeryReconstructionType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25351
UMLS 2011AA Property
C0524865
Reconstructions/Diversions
Description

SurgeryReconstructionInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25351
UMLS 2011AA Property
C0524865
Extent Of Resection
Description

Extent Of Resection

Extent of Resection
Description

SurgicalResectionPerformedAnatomicSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus ObjectClass
C25698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass-2
C15232
UMLS 2011AA ObjectClass
C0728940
Extent of Resection
Description

SurgicalResectionPerformedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C25698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass-2
C15232
UMLS 2011AA ObjectClass
C0728940
Peritonectomy
Description

Peritonectomy

Peritonectomy
Description

PeritoneumSurgicalProcedureType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12770
UMLS 2011AA ObjectClass
C0031153
NCI Thesaurus Property
C15329
UMLS 2011AA Property
C0543467
Peritonectomy
Description

PeritoneumSurgicalProcedureInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C12770
UMLS 2011AA ObjectClass
C0031153
NCI Thesaurus Property
C15329
UMLS 2011AA Property
C0543467
Residual disease
Description

Residual disease

Residual disease after cytoreduction, CC Score
Description

ResidualDiseasePostResectionDescriptionCCScoreValue

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C37895
UMLS 2011AA ObjectClass-2
C1609982
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15232
UMLS 2011AA Property-2
C0728940
NCI Thesaurus Property-3
C25365
UMLS 2011AA Property-3
C0678257
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Residual disease after cytoreduction, RR Score
Description

ResidualDiseasePostResectionDescriptionRRScoreValue

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C37895
UMLS 2011AA ObjectClass-2
C1609982
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15232
UMLS 2011AA Property-2
C0728940
NCI Thesaurus Property-3
C25365
UMLS 2011AA Property-3
C0678257
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Footer Module
Description

Footer Module

Completed by
Description

Person Completing Form

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Date Form Completed
Description

Date Form Completed

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
Phone
Description

Person Completing Form Phone

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25190
UMLS CUI-2
C1515258
NCI Thesaurus ObjectClass-2
C25657
NCI Thesaurus Property
C25395
Fax
Description

ResponsiblePersonFaxNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25657
UMLS 2011AA ObjectClass-2
C1273518
NCI Thesaurus Property
C25210
UMLS 2011AA Property
C0085205
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1 forms
  1. StudyEvent: USMCI 8214/Z6091: Surgical Data Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient demographics
Item
Visit
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
CL.1
Code List
Visit
CL Item
Post Surgery (Post Surgery)
Patient Study ID
Item
Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Item Group
Assessment of surgery
ProtocolSurgeryPerformedInd-3
Item
Was surgery performed
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C0442711 (UMLS 2011AA ObjectClass-2)
Item
Reason surgery not performed
text
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.3
Code List
Reason surgery not performed
CL Item
Patient Refusal And Withdrawal From Trial (Patient refusal and withdrawal from trial)
CL Item
Physician Decision (Physician decision)
C48250 (NCI Thesaurus)
C1709536 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
ProtocolSurgeryNotPerformedSpecify
Item
Other, specify
text
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
SurgeryCompleteInd-2
Item
Was attempted surgery completed
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
SurgeonFirstInitialsName
Item
Surgeon's First Initial
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C18071 (NCI Thesaurus ObjectClass)
C0582175 (UMLS 2011AA ObjectClass)
C40974 (NCI Thesaurus Property)
C1443235 (UMLS 2011AA Property)
SurgeonLastName
Item
Surgeon's Last Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C18071 (NCI Thesaurus ObjectClass)
C0582175 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
C40975 (NCI Thesaurus Property)
C1301584 (UMLS 2011AA Property)
Surgery Date
Item
Surgery Date
date
C25164 (NCI Thesaurus ValueDomain)
C1628561 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C15329 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
Duration of Surgery
Item
Surgery Duration
float
C15329 (NCI Thesaurus ObjectClass)
C0488629 (UMLS CUI-1)
C25275 (NCI Thesaurus Property)
C25330 (NCI Thesaurus ValueDomain)
BloodLossAmount
Item
Estimated blood loss
float
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C25559 (NCI Thesaurus Property)
C1517945 (UMLS 2011AA Property)
C25417 (NCI Thesaurus ValueDomain)
PackedRedBloodCellTransfusionReceivedUnitCount
Item
Total number of units PRBC
float
C44278 (NCI Thesaurus ValueDomain)
C0439148 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C15409 (NCI Thesaurus ObjectClass)
C0199962 (UMLS 2011AA ObjectClass)
AscitesDrainageInd-2
Item
Ascites drained
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C2885 (NCI Thesaurus ObjectClass)
C0003962 (UMLS 2011AA ObjectClass)
C50434 (NCI Thesaurus Property)
C0013103 (UMLS 2011AA Property)
IntraperitonealChemotherapyAdministeredInd-2
Item
Intraperitoneal heated chemotherapy administered
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C13352 (NCI Thesaurus ObjectClass-2)
C0442120 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
MitomycinAgentAdministeredDose
Item
Mitomycin dose
float
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C663 (NCI Thesaurus ObjectClass-2)
C0026254 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C1708 (NCI Thesaurus ValueDomain-2)
C0450442 (UMLS 2011AA ValueDomain-2)
SurgicalProcedureTargetChemotherapyTemperatureValue
Item
Target inflow temperature (Degree Celsius)
float
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C15632 (NCI Thesaurus Property)
C0392920 (UMLS 2011AA Property)
C25206 (NCI Thesaurus Property-2)
C0039476 (UMLS 2011AA Property-2)
C25702 (NCI Thesaurus Property-3)
C1521840 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
SurgicalProcedurePerfusionVolumeValue
Item
Perfusate volume (L)
float
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25335 (NCI Thesaurus Property)
C0449468 (UMLS 2011AA Property)
C15295 (NCI Thesaurus Property-2)
C0031001 (UMLS 2011AA Property-2)
Item Group
Peritoneal Carcinomatosis Index
Item
Anatomic region
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
CL.7
Code List
Anatomic region
CL Item
Central (Central)
C0205099 (NCI Metathesaurus)
CL Item
Right Upper (Right Upper)
CL Item
Epigastric (Epigastrium)
CL Item
Left Upper (Left Upper)
CL Item
Left Flank (Left flank)
CL Item
Left Lower (Left Lower)
CL Item
Pelvis (Pelvis)
CL Item
Right Lower (Right Lower)
CL Item
Right Flank (Right flank)
CL Item
Upper Jejunum (Upper jejunum)
CL Item
Lower Jejunum (Lower jejunum)
CL Item
Upper Ileum (Upper ileum)
CL Item
Lower Ileum (Lower ileum)
PeritonealCarcinomatosisExploratorySurgeryInvolvementScore
Item
PCI at exploration
float
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
C66747 (NCI Thesaurus Property-2)
C1880637 (UMLS 2011AA Property-2)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
PeritonealCarcinomatosisLaparoscopyInvolvementScore
Item
CT/Laparoscopic PCI
float
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
PeritonealCarcinomatosisPostSurgicalProcedureInvolvementScore
Item
PCI at completion
float
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15329 (NCI Thesaurus Property-2)
C0543467 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
PeritonealCarcinomatosisLaparoscopyInvolvementTotalScore
Item
Total PCI Score (CT/Laparoscopic PCI)
float
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25338 (NCI Thesaurus ValueDomain-2)
C0449820 (UMLS 2011AA ValueDomain-2)
PeritonealCarcinomatosisExploratorySurgeryInvolvementTotalScore
Item
Total PCI Score (PCI at Exploration)
float
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
C66747 (NCI Thesaurus Property-2)
C1880637 (UMLS 2011AA Property-2)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25338 (NCI Thesaurus ValueDomain-2)
C0449820 (UMLS 2011AA ValueDomain-2)
PeritonealCarcinomatosisPostSurgicalProcedureInvolvementTotalScore
Item
Total PCI Score (PCI at Completion)
float
C25313 (NCI Thesaurus ObjectClass)
C0442034 (UMLS 2011AA ObjectClass)
C3693 (NCI Thesaurus ObjectClass-2)
C0205699 (UMLS 2011AA ObjectClass-2)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15329 (NCI Thesaurus Property-2)
C0543467 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25338 (NCI Thesaurus ValueDomain-2)
C0449820 (UMLS 2011AA ValueDomain-2)
Item Group
Reconstructions/diversions
Item
Reconstructions/Diversions
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus Property)
C0524865 (UMLS 2011AA Property)
CL.8
Code List
Reconstructions/Diversions
CL Item
Small Bowel-to-small Bowel (Small bowel-to-small bowel)
CL Item
Small Bowel-to-colon (Small bowel-to-colon)
CL Item
Small Bowel-to-rectum (Small bowel-to-rectum)
CL Item
Gastrojejunostomy (Gastrojejunostomy)
CL Item
Colo-colostomy (Colo-colostomy)
CL Item
Ileostomy (Ileostomy)
C15257 (NCI Thesaurus)
C0020883 (UMLS 2011AA)
CL Item
Colostomy (Colostomy)
C15211 (NCI Thesaurus)
C0009410 (UMLS 2011AA)
CL Item
Tube Jejunostomy (Tube jejunostomy)
CL Item
Tube Gastrostomy (Tube gastrostomy)
CL Item
Peritoneal Drainage Tube(s) (Peritoneal drainage tube(s))
SurgeryReconstructionInd-2
Item
Reconstructions/Diversions
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus Property)
C0524865 (UMLS 2011AA Property)
Item Group
Extent Of Resection
Item
Extent of Resection
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25698 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15232 (NCI Thesaurus ObjectClass-2)
C0728940 (UMLS 2011AA ObjectClass)
CL.10
Code List
Extent of Resection
CL Item
Stomach (Stomach)
C12391 (NCI Thesaurus)
C0038351 (UMLS 2011AA)
CL Item
Gallbladder (Gallbladder)
C12377 (NCI Thesaurus)
C0016976 (UMLS 2011AA)
CL Item
Small Bowel (Small Bowel)
C12386 (NCI Thesaurus)
C0021852 (UMLS 2011AA)
CL Item
Colon (Colon)
C12382 (NCI Thesaurus)
C0009368 (UMLS 2011AA)
CL Item
Rectum (Rectum)
C12390 (NCI Thesaurus)
C0034896 (UMLS 2011AA)
CL Item
Greater Omentum (Greater Omentum)
C32697 (NCI Thesaurus)
C0230259 (UMLS 2011AA)
CL Item
Lesser Omentum (Lesser Omentum)
C32981 (NCI Thesaurus)
C0230260 (UMLS 2011AA)
CL Item
Pancreas (Pancreas)
C12393 (NCI Thesaurus)
C0030274 (UMLS 2011AA)
CL Item
Uterus (Uterus)
C12405 (NCI Thesaurus)
C0042149 (UMLS 2011AA)
CL Item
Ovary Fallopian Tube (Fallopian tubes/Ovaries)
C12404 (NCI Thesaurus)
C0029939 (UMLS 2011AA)
C12403 (NCI Thesaurus-3)
C0015560 (UMLS 2011AA-4)
CL Item
Bladder (Bladder)
C12414 (NCI Thesaurus)
C0005682 (UMLS 2011AA)
SurgicalResectionPerformedInd-2
Item
Extent of Resection
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25698 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15232 (NCI Thesaurus ObjectClass-2)
C0728940 (UMLS 2011AA ObjectClass)
Item Group
Peritonectomy
Item
Peritonectomy
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12770 (NCI Thesaurus ObjectClass)
C0031153 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus Property)
C0543467 (UMLS 2011AA Property)
CL.12
Code List
Peritonectomy
CL Item
Parietal (Parietal)
C25312 (NCI Thesaurus)
C0442030 (UMLS 2011AA)
CL Item
Omental Bursa (Omental Bursa)
C81014 (NCI Thesaurus)
C0230212 (UMLS 2011AA)
CL Item
Pelvic (Pelvic)
C25399 (NCI Thesaurus)
C0030797 (UMLS 2011AA)
CL Item
Right Upper (Right Upper)
CL Item
Left Upper (Left Upper)
PeritoneumSurgicalProcedureInd-2
Item
Peritonectomy
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12770 (NCI Thesaurus ObjectClass)
C0031153 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus Property)
C0543467 (UMLS 2011AA Property)
Item Group
Residual disease
Item
Residual disease after cytoreduction, CC Score
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C37895 (NCI Thesaurus ObjectClass-2)
C1609982 (UMLS 2011AA ObjectClass-2)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property-2)
C25365 (NCI Thesaurus Property-3)
C0678257 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
CL.14
Code List
Residual disease after cytoreduction, CC Score
CL Item
No Residual Disease (CC0)
CL Item
Residual Disease < 0.25 Cm (CC1)
CL Item
Residual Disease 0.25-2.5 Cm (CC2)
CL Item
Residual Disease > 2.5 Cm (CC3)
Item
Residual disease after cytoreduction, RR Score
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C37895 (NCI Thesaurus ObjectClass-2)
C1609982 (UMLS 2011AA ObjectClass-2)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property-2)
C25365 (NCI Thesaurus Property-3)
C0678257 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
CL.15
Code List
Residual disease after cytoreduction, RR Score
CL Item
Complete Removal Of All Visible Tumor With Negative Microscopic Margins Or Cytology (R0)
CL Item
Complete Removal Of All Visible Tumor With Positive Microscopic Margins Or Cytology (R1)
CL Item
Minimal Residual Tumor Nodule(s) Disease =< 0.5 Cm (R2a)
CL Item
Gross Residual Tumor Nodule(s) > 0.5 Cm, But =< 2.0 Cm (R2b)
CL Item
Extensive Residual Disease Remaining, Nodule(s) > 2.0 Cm (R2c)
Item Group
Footer Module
Person Completing Form
Item
Completed by
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Date Form Completed
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Person Completing Form Phone
Item
Phone
text
C25337 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
ResponsiblePersonFaxNumber
Item
Fax
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C1273518 (UMLS 2011AA ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS 2011AA Property)
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