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
  2. 1/9/15
  3. 7/3/15
Uploaded on:

July 3, 2015

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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

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

  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
Are data amended (check box if yes, and circle amended items)
Hepatic surgery
Was hepatic surgery initiated? (If no, disregard remaining questions.)
cm
Was gross extrahepatic disease identified (non-contiguous metastases)
Hepatic Lesions
Was any hepatic margin determined to be grossly or microscopically positive on intraoperative evaluation
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)
A positive margin was (If yes, mark all that apply)
Placement Of Intra-arterial Catheter
Was intra-arterial catheter implanted (If no, mark primary reason.)
Pump type (IF yes,)
Primary Reason
Final Pathology Report
Were final histologic margins negative for all resected metastatic lesions
Post-Surgery Treatment Plan
Documentation Submitted with Form SP (Mark all that apply.)

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