ID

11376

Description

NSABP PROTOCOL C-09: Surgery/Pathology Report Form NCT00268463 Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC8164B8-5C86-09B5-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FC8164B8-5C86-09B5-E034-0003BA3F9857

Keywords

Versions (3)
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on

July 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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NSABP PROTOCOL C-09: Surgery/Pathology Report Form NCT00268463

English

Complete and submit Form SP as soon as possible after the patient's hepatic surgery

1 forms  
  1. StudyEvent: NSABP PROTOCOL C-09: Surgery/Pathology Report Form
    1. Complete and submit Form SP as soon as possible after the patient's hepatic surgery
Header
Description

Header

Patient Initials (Last First Middle)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
NSABP Patient ID
Description

Patient ID NSABP

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1513905
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C15818
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
Affiliate Name
Description

Affiliate Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C21541
UMLS CUI-1
C1510825
NCI Thesaurus ObjectClass-2
C25413
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Person Completing Form Last Name
Description

Person Completing Form Last Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1301584
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25551
NCI Thesaurus ValueDomain
C25191
Person Completing Form First Name
Description

Person Completing Form First Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1443235
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25509
NCI Thesaurus ValueDomain
C25191
Person Completing Form 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
Are data amended (check box if yes, and circle amended items)
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Investigator Number
Description

PhysicianInvestigatorIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C17089
UMLS 2011AA ObjectClass-2
C0035173
Investigator Name
Description

InvestigatorName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
Hepatic surgery
Description

Hepatic surgery

Was hepatic surgery initiated? (If no, disregard remaining questions.)
Description

SurgicalProcedureLiverInitiationInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C12392
UMLS 2011AA Property
C0023884
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property-2
C47938
UMLS 2011AA Property-2
C1704686
Date of Hepatic Surgery (Month Day Year)
Description

SurgeryLiverPerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C12392
UMLS 2011AA Property
C0023884
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
Size of largest ablated lesion (Leave boxes blank if ablation was not employed.)
Description

AblationNeoplasmSizeDiameterMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C20985
UMLS 2011AA ObjectClass-2
C0547070
NCI Thesaurus Property
C25681
UMLS 2011AA Property
C0456389
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain-2
C25285
UMLS 2011AA ValueDomain-2
C1301886
cm
Was gross extrahepatic disease identified (non-contiguous metastases)
Description

GrossExtrahepaticDiseaseIdentifiedInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass-2
C28358
UMLS 2011AA ObjectClass-2
C1517058
NCI Thesaurus ObjectClass-3
C43566
UMLS 2011AA ObjectClass-3
C0439806
NCI Thesaurus Property
C25737
UMLS 2011AA Property
C0205396
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Hepatic Lesions
Description

Hepatic Lesions

TOTAL (according to intraoperative palpation or intraoperative ultrasound 0=none)
Description

HepaticLesionTotalIdentifiedNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property-2
C25737
UMLS 2011AA Property-2
C0205396
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ValueDomain
C0577053
TOTAL Treated (by resection and/or ablation 0=none)
Description

HepaticLesionTotalTreatmentNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property-2
C15368
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ValueDomain
C0577053
Hepatic Surgical Resection
Description

HepaticLesionSurgicalResectionTreatmentCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C15368
NCI Thesaurus Property-2
C15232
UMLS 2011AA Property
C0728940
NCI Metathesaurus Property
CL052737
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Hepatic Cryoablation
Description

SurgicalProcedureHepaticLesionCryosurgeryPerformedCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C15368
NCI Thesaurus Property-2
C15215
UMLS 2011AA Property
C0010408
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Hepatic Radiofrequency Ablation
Description

HepaticLesionRadiofrequencyAblationTreatmentNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C15368
NCI Thesaurus Property-2
C20985
UMLS 2011AA Property
C0547070
NCI Metathesaurus Property
C0920725
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ValueDomain
C0577053
Was any hepatic margin determined to be grossly or microscopically positive on intraoperative evaluation
Description

PositiveHepaticMarginIntraoperativeEvaluationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus ObjectClass-2
C25246
UMLS 2011AA ObjectClass-2
C1446409
NCI Thesaurus ObjectClass-3
C25563
UMLS 2011AA ObjectClass-3
C0205284
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Metathesaurus Property
CL223124
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is there explicit documentation in the operative report that a rim of normal liver tissue at the positive margin was ablated or resected during the surgical procedure (if yes)
Description

PositiveMarginOperativeReportDocumentedInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25246
UMLS 2011AA ObjectClass
C1446409
NCI Thesaurus ObjectClass-2
C25563
UMLS 2011AA ObjectClass-2
C0205284
NCI Thesaurus Property
C25356
UMLS 2011AA Property
C1301725
NCI Metathesaurus Property
CL278863
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
A positive margin was (If yes, mark all that apply)
Description

PositiveHepaticMarginTreatmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus ObjectClass-2
C25246
UMLS 2011AA ObjectClass-2
C1446409
NCI Thesaurus ObjectClass-3
C25563
UMLS 2011AA ObjectClass-3
C0205284
NCI Thesaurus Property
C15368
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Placement Of Intra-arterial Catheter
Description

Placement Of Intra-arterial Catheter

Was intra-arterial catheter implanted (If no, mark primary reason.)
Description

Intra-arterialCatheterPatientAdministeredInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C17446
UMLS 2011AA ObjectClass-2
C0085590
NCI Metathesaurus ObjectClass
C0694634
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Pump type (IF yes,)
Description

IntrahepaticInfusionProcedureCatheterPumpType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C17446
UMLS 2011AA Property
C0085590
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property-2
C17625
UMLS 2011AA Property-2
C0182537
Primary Reason
Description

Intra-arterialCatheterPatientNotAdministeredReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C17446
UMLS 2011AA ObjectClass-2
C0085590
NCI Metathesaurus ObjectClass
C0694634
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Description

Intra-arterialCatheterPatientNotAdministeredSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C17446
UMLS 2011AA ObjectClass-2
C0085590
NCI Metathesaurus ObjectClass
C0694634
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Final Pathology Report
Description

Final Pathology Report

Number Examined
Description

HepaticLesionExaminedNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C25500
UMLS 2011AA Property
C0332128
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ValueDomain
C0577053
Number Positive
Description

HepaticLesionPositiveConfirmedNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C13308
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C25458
UMLS 2011AA Property
C0750484
NCI Thesaurus Property-2
C25246
UMLS 2011AA Property-2
C1446409
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ValueDomain
C0577053
Were final histologic margins negative for all resected metastatic lesions
Description

ResectedMetastaticLesionNegativeMarginInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus ObjectClass-2
C14174
UMLS 2011AA ObjectClass-2
C0036525
NCI Thesaurus ObjectClass-3
C25654
UMLS 2011AA ObjectClass-3
C1521996
NCI Thesaurus Property
C25247
UMLS 2011AA Property
C0205160
NCI Thesaurus Property-2
C25563
UMLS 2011AA Property-2
C0205284
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Number Examined
Description

PortalNodeExaminedNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C45804
UMLS 2011AA ObjectClass
C0746922
NCI Thesaurus ObjectClass-2
C38007
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C25500
UMLS 2011AA Property
C0332128
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C45804
UMLS 2011AA ValueDomain-2
C0746922
NCI Thesaurus ValueDomain-3
C38007
UMLS 2011AA ValueDomain-3
C0205054
Number Positive
Description

PortalNodePositiveConfirmedNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C45804
UMLS 2011AA ObjectClass
C0746922
NCI Thesaurus ObjectClass-2
C38007
UMLS 2011AA ObjectClass-2
C0205054
NCI Thesaurus Property
C25458
UMLS 2011AA Property
C0750484
NCI Thesaurus Property-2
C25246
UMLS 2011AA Property-2
C1446409
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C45804
UMLS 2011AA ValueDomain-2
C0746922
NCI Thesaurus ValueDomain-3
C38007
UMLS 2011AA ValueDomain-3
C0205054
Post-Surgery Treatment Plan
Description

PostHepaticSurgeryTreatmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus ObjectClass-2
C38008
UMLS 2011AA ObjectClass-2
C0687676
NCI Thesaurus ObjectClass-3
C15329
UMLS 2011AA ObjectClass-3
C0543467
NCI Thesaurus Property
C15368
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
explain the REASON for the "OTHER PLAN" (When applicable, and briefly describe the intended treatment)
Description

PostHepaticSurgeryTreatmentSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus ObjectClass-2
C38008
UMLS 2011AA ObjectClass-2
C0687676
NCI Thesaurus ObjectClass-3
C15329
UMLS 2011AA ObjectClass-3
C0543467
NCI Thesaurus Property
C15368
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Documentation Submitted with Form SP (Mark all that apply.)
Description

SurgeryPathologyFormDocumentationSubmittedType

Data type

text

Alias
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus ObjectClass-2
C17173
UMLS 2011AA ObjectClass-2
C0038894
NCI Thesaurus ObjectClass-3
C18189
UMLS 2011AA ObjectClass-3
C0030664
NCI Thesaurus Property
C25695
UMLS 2011AA Property
C1515023
NCI Metathesaurus Property
C0920316
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Comments (optional)
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
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Similar models

Complete and submit Form SP as soon as possible after the patient's hepatic surgery

1 forms
  1. StudyEvent: NSABP PROTOCOL C-09: Surgery/Pathology Report Form
    1. Complete and submit Form SP as soon as possible after the patient's hepatic surgery
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Patient Initials
Item
Patient Initials (Last First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
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)
Affiliate Name
Item
Affiliate Name
text
C21541 (NCI Thesaurus ObjectClass)
C1510825 (UMLS CUI-1)
C25413 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Person Completing Form Last Name
Item
Person Completing Form Last Name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Person Completing Form First Name
Item
Person Completing Form First Name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1443235 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Person Completing Form Phone
Item
Person Completing Form 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)
Data amended
Item
Are data amended (check box if yes, and circle amended items)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
PhysicianInvestigatorIdentifierNumber
Item
Investigator Number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C17089 (NCI Thesaurus ObjectClass-2)
C0035173 (UMLS 2011AA ObjectClass-2)
InvestigatorName
Item
Investigator Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
Item Group
Hepatic surgery
SurgicalProcedureLiverInitiationInd-2
Item
Was hepatic surgery initiated? (If no, disregard remaining questions.)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12392 (NCI Thesaurus Property)
C0023884 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C47938 (NCI Thesaurus Property-2)
C1704686 (UMLS 2011AA Property-2)
SurgeryLiverPerformedDate
Item
Date of Hepatic Surgery (Month Day Year)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12392 (NCI Thesaurus Property)
C0023884 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
AblationNeoplasmSizeDiameterMeasurement
Item
Size of largest ablated lesion (Leave boxes blank if ablation was not employed.)
float
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C20985 (NCI Thesaurus ObjectClass-2)
C0547070 (UMLS 2011AA ObjectClass-2)
C25681 (NCI Thesaurus Property)
C0456389 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
GrossExtrahepaticDiseaseIdentifiedInd-2
Item
Was gross extrahepatic disease identified (non-contiguous metastases)
boolean
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C28358 (NCI Thesaurus ObjectClass-2)
C1517058 (UMLS 2011AA ObjectClass-2)
C43566 (NCI Thesaurus ObjectClass-3)
C0439806 (UMLS 2011AA ObjectClass-3)
C25737 (NCI Thesaurus Property)
C0205396 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Hepatic Lesions
HepaticLesionTotalIdentifiedNumber
Item
TOTAL (according to intraoperative palpation or intraoperative ultrasound 0=none)
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C25737 (NCI Thesaurus Property-2)
C0205396 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0577053 (NCI Metathesaurus ValueDomain)
HepaticLesionTotalTreatmentNumber
Item
TOTAL Treated (by resection and/or ablation 0=none)
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0577053 (NCI Metathesaurus ValueDomain)
HepaticLesionSurgicalResectionTreatmentCount
Item
Hepatic Surgical Resection
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C15368 (NCI Thesaurus Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property)
CL052737 (NCI Metathesaurus Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
SurgicalProcedureHepaticLesionCryosurgeryPerformedCount
Item
Hepatic Cryoablation
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C15368 (NCI Thesaurus Property)
C15215 (NCI Thesaurus Property-2)
C0010408 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
HepaticLesionRadiofrequencyAblationTreatmentNumber
Item
Hepatic Radiofrequency Ablation
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C15368 (NCI Thesaurus Property)
C20985 (NCI Thesaurus Property-2)
C0547070 (UMLS 2011AA Property)
C0920725 (NCI Metathesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0577053 (NCI Metathesaurus ValueDomain)
PositiveHepaticMarginIntraoperativeEvaluationInd-2
Item
Was any hepatic margin determined to be grossly or microscopically positive on intraoperative evaluation
boolean
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C25246 (NCI Thesaurus ObjectClass-2)
C1446409 (UMLS 2011AA ObjectClass-2)
C25563 (NCI Thesaurus ObjectClass-3)
C0205284 (UMLS 2011AA ObjectClass-3)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
CL223124 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PositiveMarginOperativeReportDocumentedInd-2
Item
Is there explicit documentation in the operative report that a rim of normal liver tissue at the positive margin was ablated or resected during the surgical procedure (if yes)
boolean
C25246 (NCI Thesaurus ObjectClass)
C1446409 (UMLS 2011AA ObjectClass)
C25563 (NCI Thesaurus ObjectClass-2)
C0205284 (UMLS 2011AA ObjectClass-2)
C25356 (NCI Thesaurus Property)
C1301725 (UMLS 2011AA Property)
CL278863 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
A positive margin was (If yes, mark all that apply)
text
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C25246 (NCI Thesaurus ObjectClass-2)
C1446409 (UMLS 2011AA ObjectClass-2)
C25563 (NCI Thesaurus ObjectClass-3)
C0205284 (UMLS 2011AA ObjectClass-3)
C15368 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.6
Code List
A positive margin was (If yes, mark all that apply)
CL Item
Ablated (Ablated)
CL Item
Resected (Resected)
Item Group
Placement Of Intra-arterial Catheter
Intra-arterialCatheterPatientAdministeredInd-2
Item
Was intra-arterial catheter implanted (If no, mark primary reason.)
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17446 (NCI Thesaurus ObjectClass-2)
C0085590 (UMLS 2011AA ObjectClass-2)
C0694634 (NCI Metathesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Pump type (IF yes,)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C17446 (NCI Thesaurus Property)
C0085590 (UMLS 2011AA Property)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C17625 (NCI Thesaurus Property-2)
C0182537 (UMLS 2011AA Property-2)
CL.8
Code List
Pump type (IF yes,)
CL Item
External (External)
C44280 (NCI Thesaurus)
C0205101 (UMLS 2011AA)
CL Item
Internal (Internal)
C25234 (NCI Thesaurus)
C0205102 (UMLS 2011AA)
Item
Primary Reason
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17446 (NCI Thesaurus ObjectClass-2)
C0085590 (UMLS 2011AA ObjectClass-2)
C0694634 (NCI Metathesaurus ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.9
Code List
Primary Reason
CL Item
Unable To Cannulate Artery (Unable to cannulate artery)
CL Item
Other Technical Difficulty (Other technical difficulty)
CL Item
Patient Refused (Patient refused)
CL Item
Medical Reasons (Medical reasons)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Intra-arterialCatheterPatientNotAdministeredSpecify
Item
Other, specify
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17446 (NCI Thesaurus ObjectClass-2)
C0085590 (UMLS 2011AA ObjectClass-2)
C0694634 (NCI Metathesaurus ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Final Pathology Report
HepaticLesionExaminedNumber
Item
Number Examined
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0577053 (NCI Metathesaurus ValueDomain)
HepaticLesionPositiveConfirmedNumber
Item
Number Positive
float
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C13308 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
C25246 (NCI Thesaurus Property-2)
C1446409 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0577053 (NCI Metathesaurus ValueDomain)
ResectedMetastaticLesionNegativeMarginInd-2
Item
Were final histologic margins negative for all resected metastatic lesions
boolean
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C14174 (NCI Thesaurus ObjectClass-2)
C0036525 (UMLS 2011AA ObjectClass-2)
C25654 (NCI Thesaurus ObjectClass-3)
C1521996 (UMLS 2011AA ObjectClass-3)
C25247 (NCI Thesaurus Property)
C0205160 (UMLS 2011AA Property)
C25563 (NCI Thesaurus Property-2)
C0205284 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PortalNodeExaminedNumber
Item
Number Examined
float
C45804 (NCI Thesaurus ObjectClass)
C0746922 (UMLS 2011AA ObjectClass)
C38007 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C45804 (NCI Thesaurus ValueDomain-2)
C0746922 (UMLS 2011AA ValueDomain-2)
C38007 (NCI Thesaurus ValueDomain-3)
C0205054 (UMLS 2011AA ValueDomain-3)
PortalNodePositiveConfirmedNumber
Item
Number Positive
float
C45804 (NCI Thesaurus ObjectClass)
C0746922 (UMLS 2011AA ObjectClass)
C38007 (NCI Thesaurus ObjectClass-2)
C0205054 (UMLS 2011AA ObjectClass-2)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
C25246 (NCI Thesaurus Property-2)
C1446409 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C45804 (NCI Thesaurus ValueDomain-2)
C0746922 (UMLS 2011AA ValueDomain-2)
C38007 (NCI Thesaurus ValueDomain-3)
C0205054 (UMLS 2011AA ValueDomain-3)
Item
Post-Surgery Treatment Plan
text
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus ObjectClass-2)
C0687676 (UMLS 2011AA ObjectClass-2)
C15329 (NCI Thesaurus ObjectClass-3)
C0543467 (UMLS 2011AA ObjectClass-3)
C15368 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.11
Code List
Post-Surgery Treatment Plan
CL Item
Group 1 Patient: Capecitabine + Oxaliplatin (Group 1 Patient: Capecitabine + Oxaliplatin)
CL Item
Group 1 Patient: Other Plan (Group 1 Patient: Other plan)
CL Item
Group 2 Patient: Fudr + Capecitabine + Oxaliplatin (Group 2 Patient: FUDR + Capecitabine + Oxaliplatin)
CL Item
Group 2 Patient: Only Capecitabine + Oxaliplatin (Group 2 Patient: Only Capecitabine + Oxaliplatin)
CL Item
Group 2 Patient: Other Plan (Group 2 Patient: Other Plan)
PostHepaticSurgeryTreatmentSpecify
Item
explain the REASON for the "OTHER PLAN" (When applicable, and briefly describe the intended treatment)
text
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus ObjectClass-2)
C0687676 (UMLS 2011AA ObjectClass-2)
C15329 (NCI Thesaurus ObjectClass-3)
C0543467 (UMLS 2011AA ObjectClass-3)
C15368 (NCI Thesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Documentation Submitted with Form SP (Mark all that apply.)
text
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C17173 (NCI Thesaurus ObjectClass-2)
C0038894 (UMLS 2011AA ObjectClass-2)
C18189 (NCI Thesaurus ObjectClass-3)
C0030664 (UMLS 2011AA ObjectClass-3)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
C0920316 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.12
Code List
Documentation Submitted with Form SP (Mark all that apply.)
CL Item
Operative Report (Operative report)
CL Item
Pathology Report (Pathology report)
CL Item
Report Of Intraoperative Ultrasound (Report of intraoperative ultrasound)
CL Item
Report Of Post-operative Ct Or Mri Scan Of Abdomen (Report of post-operative CT or MRI scan of abdomen)
CL Item
Report Of Postoperative Arterial Flow Scan With Form Maa (Report of postoperative arterial flow scan with Form MAA)
Research Comments
Item
Comments (optional)
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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