ID

8679

Description

Z6051 Rectal Surgery Form (RS) Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=433B815D-7043-2896-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=433B815D-7043-2896-E044-0003BA3F9857

Keywords

Versions (2)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00726622 Treatment - Z6051 Rectal Surgery Form (RS) - 2718972v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Z6051 Rectal Surgery Form (RS)
    1. No Instruction available.
Header Module
Description

Header Module

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 (Pt. ID issued during registration unless pt. previously registered to an ACOSOG study.)
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
Patient Initials
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
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
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
Surgery
Description

Surgery

Did the patient have surgery as part of protocol treatment?
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
Date of Resection
Description

PatientSurgicalResectionDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25698
NCI Thesaurus Property-2
C15232
UMLS 2011AA Property
C0728940
Surgical Approach
Description

SurgicalProcedureColorectalCarcinomaPerformedType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property-2
C2955
UMLS 2011AA Property-2
C0009402
Was an ostomy created at the time of resection?
Description

OstomyExcisionPerformedIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C15232
UMLS 2011AA Property-2
C0728940
NCI Thesaurus ObjectClass
C15290
UMLS 2011AA ObjectClass
C0029473
Open to close operative time (minutes)
Description

ColorectalSurgicalProcedurePerformedMinuteTime

Data type

time

Measurement units
  • min
Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C48154
UMLS 2011AA ValueDomain
C0439232
NCI Thesaurus ValueDomain-2
C25207
UMLS 2011AA ValueDomain-2
C0040223
min
Estimated blood loss (Total - ml)
Description

TotalEstimateBloodLossAmount

Data type

float

Alias
NCI Thesaurus ObjectClass
C25304
UMLS 2011AA ObjectClass
C0439810
NCI Thesaurus ObjectClass-2
C25498
UMLS 2011AA ObjectClass-2
C0750572
NCI Thesaurus ObjectClass-3
C12434
UMLS 2011AA ObjectClass-3
C0229664
NCI Thesaurus Property
C25559
UMLS 2011AA Property
C1517945
NCI Thesaurus ValueDomain
C25417
Sphincter preservation planned prior to surgery
Description

ColorectalSurgicalProcedureSphincterPreservationProcedurePlanInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C25619
UMLS 2011AA Property
C1301732
NCI Thesaurus Property-2
C28381
UMLS 2011AA Property-2
C1409894
NCI Thesaurus Property-3
C19232
UMLS 2011AA Property-3
C1514402
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Final incision length (cm)
Description

ColorectalSurgicalProcedureSurgicalIncisionLengthPerformedMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C15384
UMLS 2011AA Property-2
C0184898
NCI Thesaurus Property-3
C25334
UMLS 2011AA Property-3
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Margins examined by frozen section
Description

SurgicalMarginFrozenSectionDiagnosisInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C49338
UMLS 2011AA Property
C0085188
NCI Thesaurus ObjectClass
C41227
UMLS 2011AA ObjectClass
C0229985
Intra-operative distal margin length (cm)
Description

ColorectalSurgicalMarginDistalDistanceMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C41227
UMLS 2011AA ObjectClass-2
C0229985
NCI Thesaurus Property
C25237
UMLS 2011AA Property
C0205108
NCI Thesaurus Property-2
C25167
UMLS 2011AA Property-2
C0012751
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Rectum intact
Description

ColorectalSurgicalProcedureRectumIntactPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C12390
UMLS 2011AA Property
C0034896
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus Property-3
C62399
UMLS 2011AA Property-3
C0205266
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Video documentation
Description

ColorectalSurgicalProcedureVisualDocumentInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C38059
UMLS 2011AA Property
C0234621
NCI Thesaurus Property-2
C70899
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Was attempted surgery complete
Description

ColorectalSurgicalProcedureAttemptCompleteInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property-2
C39769
UMLS 2011AA Property-2
C1516084
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
For Patients Randomized To Laproscopic Surgery Only
Description

For Patients Randomized To Laproscopic Surgery Only

Surgical approach
Description

SurgicalProcedureApproachType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25424
UMLS 2011AA Property
C0449445
Port Number
Description

SurgicalProcedureLaparoscopicPortIdentifierNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property-2
C79080
UMLS 2011AA Property-2
C2697883
Port Size
Description

SurgicalProcedureLaparoscopicPortSize2DigitMMMeasurement

Data type

float

Measurement units
  • mm
Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25681
UMLS 2011AA Property
C0456389
NCI Thesaurus Property-2
C79080
UMLS 2011AA Property-2
C2697883
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain-2
C28251
UMLS 2011AA ValueDomain-2
C0439200
NCI Thesaurus ValueDomain-3
C45255
UMLS 2011AA ValueDomain-3
C1708523
NCI Thesaurus ValueDomain-4
C73791
UMLS 2011AA ValueDomain-4
C0582802
mm
Port Size
Description

SurgicalProcedureLaparoscopicPortSize2DigitMMMeasurement

Data type

float

Measurement units
  • mm
Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25681
UMLS 2011AA Property
C0456389
NCI Thesaurus Property-2
C79080
UMLS 2011AA Property-2
C2697883
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain-2
C28251
UMLS 2011AA ValueDomain-2
C0439200
NCI Thesaurus ValueDomain-3
C45255
UMLS 2011AA ValueDomain-3
C1708523
NCI Thesaurus ValueDomain-4
C73791
UMLS 2011AA ValueDomain-4
C0582802
mm
Port Pattern
Description

SurgicalProcedureLaparoscopicPortLocationLaparoscopicPortLocationAnatomicSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property-2
C79080
UMLS 2011AA Property-2
C2697883
Hand Port
Description

SurgicalProcedureHandLaparoscopicPortPerformedInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C32712
UMLS 2011AA Property-2
C0018563
NCI Thesaurus Property-3
C79080
UMLS 2011AA Property-3
C2697883
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Site
Description

SurgicalProcedureHandLaparoscopicPortAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C32712
UMLS 2011AA Property-2
C0018563
NCI Thesaurus Property-3
C79080
UMLS 2011AA Property-3
C2697883
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Ligation Method
Description

SurgicalProcedureLaparoscopyLigationMethodType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C15270
UMLS 2011AA Property-2
C0023690
NCI Thesaurus Property-3
C71460
UMLS 2011AA Property-3
C0025663
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other specify
Description

SurgicalProcedureLaparoscopyLigationMethodSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C15270
UMLS 2011AA Property-2
C0023690
NCI Thesaurus Property-3
C71460
UMLS 2011AA Property-3
C0025663
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C15368
TME Dissection Instrument
Description

SurgicalProcedureLaparoscopyTotalMesorectalExcisionMedicalDeviceType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C16830
UMLS 2011AA Property-2
C0025080
NCI Thesaurus Property-3
C16180
UMLS 2011AA Property-3
C1273428
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other specify
Description

SurgicalProcedureLaparoscopyTotalMesorectalExcisionMedicalDeviceSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C16830
UMLS 2011AA Property-2
C0025080
NCI Thesaurus Property-3
C16180
UMLS 2011AA Property-3
C1273428
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C15368
Low Rectal Transection Stapler Type
Description

SurgicalProcedureLaparoscopyRectalExcisionStaplerMedicalDeviceType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C16830
UMLS 2011AA Property-2
C0025080
NCI Thesaurus Property-3
C25224
UMLS 2011AA Property-3
C0205052
NCI Thesaurus Property-4
C15232
UMLS 2011AA Property-4
C0728940
NCI Thesaurus Property-5
C79082
UMLS 2011AA Property-5
C0038938
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Number of firing
Description

SurgicalProcedureLaparoscopyRectalExcisionSurgicalStaplerMedicalDeviceCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C16830
UMLS 2011AA Property-2
C0025080
NCI Thesaurus Property-3
C25224
UMLS 2011AA Property-3
C0205052
NCI Thesaurus Property-4
C15232
UMLS 2011AA Property-4
C0728940
NCI Thesaurus Property-5
C79082
UMLS 2011AA Property-5
C0038938
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Other, specify
Description

SurgicalProcedureLaparoscopyRectalExcisionStaplerMedicalDeviceSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C16830
UMLS 2011AA Property-2
C0025080
NCI Thesaurus Property-3
C25224
UMLS 2011AA Property-3
C0205052
NCI Thesaurus Property-4
C15232
UMLS 2011AA Property-4
C0728940
NCI Thesaurus Property-5
C79082
UMLS 2011AA Property-5
C0038938
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Scope Used
Description

SurgicalProcedureLaparoscopeUseLaparoscopeType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus Property-3
C28167
UMLS 2011AA Property-3
C0023036
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other specify
Description

SurgicalProcedureLaparoscopeUseSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus Property-3
C28167
UMLS 2011AA Property-3
C0023036
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain-2
C15368
Was a change in ports required
Description

SurgicalProcedureLaparoscopicPortChangeLocationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25446
UMLS 2011AA Property-2
C0392747
NCI Thesaurus Property-3
C79080
UMLS 2011AA Property-3
C2697883
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Were retractors needed
Description

SurgicalProcedureLaparoscopicRetractorsUseTherapyInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
NCI Thesaurus Property-2
C79091
UMLS 2011AA Property-2
C2697884
Type of retractor
Description

SurgicalProcedureLaparoscopicRetractorUseType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
NCI Thesaurus Property-2
C79091
UMLS 2011AA Property-2
C2697884
Other, specify
Description

SurgicalProcedureLaparoscopicRetractorsUseSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
NCI Thesaurus Property-2
C79091
UMLS 2011AA Property-2
C2697884
Was there organ displacement
Description

SurgicalProcedureLaparoscopicRetractorOrganPhysicalShiftPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C13018
UMLS 2011AA Property-2
C0178784
NCI Thesaurus Property-3
C73943
UMLS 2011AA Property-3
C2347509
NCI Thesaurus Property-4
C79091
UMLS 2011AA Property-4
C2697884
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Retractor used
Description

SurgicalProcedureLaparoscopicRetractorOrganPhysicalShiftUseType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C13018
UMLS 2011AA Property
C0178784
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus Property-3
C73943
UMLS 2011AA Property-3
C2347509
NCI Thesaurus Property-4
C79091
UMLS 2011AA Property-4
C2697884
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other, specify
Description

SurgicalProcedureLaparoscopicRetractorOrganPhysicalShiftUseSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C13018
UMLS 2011AA Property
C0178784
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus Property-3
C73943
UMLS 2011AA Property-3
C2347509
NCI Thesaurus Property-4
C79091
UMLS 2011AA Property-4
C2697884
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Was a smoke evacuator used
Description

SurgicalProcedureLaparoscopicSmokeEvacuatorUseInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus Property-3
C79092
UMLS 2011AA Property-3
C2699315
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Anastomosis
Description

SurgicalProcedureAnastomosisPerformedTherapyInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C15609
UMLS 2011AA Property
C0677554
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
Method used
Description

SurgicalProcedureAnastomosisPerformedType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C15609
UMLS 2011AA Property
C0677554
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
Was laparoscopic resection converted to open
Description

ColorectalSurgicalProcedureExcisionLaparoscopyOpenPerformedInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C49069
UMLS 2011AA Property-4
C0175566
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Reason laparoscopic resection was converted to open
Description

ColorectalSurgicalProcedureExcisionLaparoscopyOpenPerformedReason

Data type

text

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C49069
UMLS 2011AA Property-4
C0175566
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other specify
Description

ColorectalSurgicalProcedureExcisionLaparoscopyOpenPerformedSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C13363
UMLS 2011AA ObjectClass
C0555952
NCI Thesaurus ObjectClass-2
C15329
UMLS 2011AA ObjectClass-2
C0543467
NCI Thesaurus Property
C16969
UMLS 2011AA Property
C0031150
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus Property-3
C15232
UMLS 2011AA Property-3
C0728940
NCI Thesaurus Property-4
C49069
UMLS 2011AA Property-4
C0175566
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Intra-operative Complications
Description

Intra-operative Complications

Intra-operative Complications
Description

AdverseEventIntraoperativeComplicationAnatomicSitePresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C41331
UMLS 2011AA ObjectClass
C0877248
NCI Thesaurus Property
C13717
UMLS 2011AA Property
C1515974
NCI Thesaurus Property-2
C25626
UMLS 2011AA Property-2
C0150312
NCI Thesaurus Property-3
C34735
UMLS 2011AA Property-3
C0021890
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Intra-operative Complications
Description

AdverseEventIntraoperativeComplicationAnatomicSitePresentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C41331
UMLS 2011AA ObjectClass
C0877248
NCI Thesaurus Property
C13717
UMLS 2011AA Property
C1515974
NCI Thesaurus Property-2
C25626
UMLS 2011AA Property-2
C0150312
NCI Thesaurus Property-3
C34735
UMLS 2011AA Property-3
C0021890
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other, specify
Description

IntrahepaticInfusionProcedureOtherComplicationSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus ObjectClass
C15731
UMLS 2011AA ObjectClass
C1134564
NCI Thesaurus Property-2
C2959
UMLS 2011AA Property-2
C0009566
Complication due to
Description

AdverseEventIntraoperativeComplicationPresentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C41331
UMLS 2011AA ObjectClass
C0877248
NCI Thesaurus Property-2
C34735
UMLS 2011AA Property-2
C0021890
Footer Module
Description

Footer Module

Completed by
Description

Responsible Person Signature

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus ObjectClass-2
C25657
NCI Thesaurus Property
C25678
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
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  1. StudyEvent: Z6051 Rectal Surgery Form (RS)
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
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
1-2 Weeks Post-surgery (1-2 weeks post-surgery)
Patient Study ID
Item
Patient ID (Pt. ID issued during registration unless pt. previously registered to an ACOSOG study.)
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (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)
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)
Item Group
Surgery
ProtocolSurgeryPerformedInd-3
Item
Did the patient have surgery as part of protocol treatment?
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)
PatientSurgicalResectionDate
Item
Date of Resection
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25698 (NCI Thesaurus Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property)
Item
Surgical Approach
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C2955 (NCI Thesaurus Property-2)
C0009402 (UMLS 2011AA Property-2)
CL.4
Code List
Surgical Approach
CL Item
Low Anterior Resection (Low anterior resection)
CL Item
Low Anterior Resection Plus Coloanal Anastomosis (Low Anterior Resection + Coloanal Anastomosis)
CL Item
Abdominal Perineal Resection (Abdominal perineal resection)
CL Item
Low Hartmann (Low Hartmann)
CL Item
Proctocolectomy (Total Proctocolectomy)
C51635 (NCI Thesaurus)
C0400076 (UMLS 2011AA)
Item
Was an ostomy created at the time of resection?
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property-2)
C15290 (NCI Thesaurus ObjectClass)
C0029473 (UMLS 2011AA ObjectClass)
CL.5
Code List
Was an ostomy created at the time of resection?
CL Item
Yes, Colostomy (Yes, colostomy)
CL Item
Yes, Ileostomy (Yes, ileostomy)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
ColorectalSurgicalProcedurePerformedMinuteTime
Item
Open to close operative time (minutes)
time
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C48154 (NCI Thesaurus ValueDomain)
C0439232 (UMLS 2011AA ValueDomain)
C25207 (NCI Thesaurus ValueDomain-2)
C0040223 (UMLS 2011AA ValueDomain-2)
TotalEstimateBloodLossAmount
Item
Estimated blood loss (Total - ml)
float
C25304 (NCI Thesaurus ObjectClass)
C0439810 (UMLS 2011AA ObjectClass)
C25498 (NCI Thesaurus ObjectClass-2)
C0750572 (UMLS 2011AA ObjectClass-2)
C12434 (NCI Thesaurus ObjectClass-3)
C0229664 (UMLS 2011AA ObjectClass-3)
C25559 (NCI Thesaurus Property)
C1517945 (UMLS 2011AA Property)
C25417 (NCI Thesaurus ValueDomain)
ColorectalSurgicalProcedureSphincterPreservationProcedurePlanInd-2
Item
Sphincter preservation planned prior to surgery
boolean
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C25619 (NCI Thesaurus Property)
C1301732 (UMLS 2011AA Property)
C28381 (NCI Thesaurus Property-2)
C1409894 (UMLS 2011AA Property-2)
C19232 (NCI Thesaurus Property-3)
C1514402 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ColorectalSurgicalProcedureSurgicalIncisionLengthPerformedMeasurement
Item
Final incision length (cm)
float
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15384 (NCI Thesaurus Property-2)
C0184898 (UMLS 2011AA Property-2)
C25334 (NCI Thesaurus Property-3)
C1444754 (UMLS 2011AA Property-3)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
SurgicalMarginFrozenSectionDiagnosisInd-2
Item
Margins examined by frozen section
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C49338 (NCI Thesaurus Property)
C0085188 (UMLS 2011AA Property)
C41227 (NCI Thesaurus ObjectClass)
C0229985 (UMLS 2011AA ObjectClass)
ColorectalSurgicalMarginDistalDistanceMeasurement
Item
Intra-operative distal margin length (cm)
float
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C41227 (NCI Thesaurus ObjectClass-2)
C0229985 (UMLS 2011AA ObjectClass-2)
C25237 (NCI Thesaurus Property)
C0205108 (UMLS 2011AA Property)
C25167 (NCI Thesaurus Property-2)
C0012751 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ColorectalSurgicalProcedureRectumIntactPerformedInd-3
Item
Rectum intact
boolean
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C12390 (NCI Thesaurus Property)
C0034896 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C62399 (NCI Thesaurus Property-3)
C0205266 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
ColorectalSurgicalProcedureVisualDocumentInd-3
Item
Video documentation
boolean
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38059 (NCI Thesaurus Property)
C0234621 (UMLS 2011AA Property)
C70899 (NCI Thesaurus Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
ColorectalSurgicalProcedureAttemptCompleteInd-2
Item
Was attempted surgery complete
boolean
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C39769 (NCI Thesaurus Property-2)
C1516084 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
For Patients Randomized To Laproscopic Surgery Only
Item
Surgical approach
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25424 (NCI Thesaurus Property)
C0449445 (UMLS 2011AA Property)
CL.11
Code List
Surgical approach
CL Item
Laparoscopic Surgery (Laparoscopic)
C15725 (NCI Thesaurus)
C0751429 (UMLS 2011AA)
CL Item
Laparoscopic-assisted (Laparoscopic-assisted)
CL Item
Hand-assisted (Hand-assisted)
CL Item
Robotic-assisted (Robotic-assisted)
SurgicalProcedureLaparoscopicPortIdentifierNumber
Item
Port Number
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C79080 (NCI Thesaurus Property-2)
C2697883 (UMLS 2011AA Property-2)
SurgicalProcedureLaparoscopicPortSize2DigitMMMeasurement
Item
Port Size
float
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25681 (NCI Thesaurus Property)
C0456389 (UMLS 2011AA Property)
C79080 (NCI Thesaurus Property-2)
C2697883 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C28251 (NCI Thesaurus ValueDomain-2)
C0439200 (UMLS 2011AA ValueDomain-2)
C45255 (NCI Thesaurus ValueDomain-3)
C1708523 (UMLS 2011AA ValueDomain-3)
C73791 (NCI Thesaurus ValueDomain-4)
C0582802 (UMLS 2011AA ValueDomain-4)
SurgicalProcedureLaparoscopicPortSize2DigitMMMeasurement
Item
Port Size
float
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25681 (NCI Thesaurus Property)
C0456389 (UMLS 2011AA Property)
C79080 (NCI Thesaurus Property-2)
C2697883 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C28251 (NCI Thesaurus ValueDomain-2)
C0439200 (UMLS 2011AA ValueDomain-2)
C45255 (NCI Thesaurus ValueDomain-3)
C1708523 (UMLS 2011AA ValueDomain-3)
C73791 (NCI Thesaurus ValueDomain-4)
C0582802 (UMLS 2011AA ValueDomain-4)
Item
Port Pattern
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C79080 (NCI Thesaurus Property-2)
C2697883 (UMLS 2011AA Property-2)
CL.12
Code List
Port Pattern
CL Item
Left Lower Quadrant (LLQ)
CL Item
Left Upper Quadrant (LUQ)
CL Item
Right Lower Quadrant (RLQ)
CL Item
Right Upper Quadrant (RUQ)
CL Item
Pubic Bone (Super Pubic)
C33423 (NCI Thesaurus)
C0034014 (UMLS 2011AA)
CL Item
Umbilicus (Umbilicus)
C77533 (NCI Thesaurus)
C0041638 (UMLS 2011AA)
CL Item
Xiphoid Process (Sub Xiphoid)
C33895 (NCI Thesaurus)
C0043356 (UMLS 2011AA)
CL Item
Left Middle Abdomen (Lt Mid Abd)
CL Item
Left Lateral Abdomen (Lt Lateral Abd)
CL Item
Right Middle Abdomen (Rt Mid Abd)
CL Item
Right Lateral Abdomen (Rt Lateral Abd)
SurgicalProcedureHandLaparoscopicPortPerformedInd-2
Item
Hand Port
boolean
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C32712 (NCI Thesaurus Property-2)
C0018563 (UMLS 2011AA Property-2)
C79080 (NCI Thesaurus Property-3)
C2697883 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Site
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C32712 (NCI Thesaurus Property-2)
C0018563 (UMLS 2011AA Property-2)
C79080 (NCI Thesaurus Property-3)
C2697883 (UMLS 2011AA Property-3)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.14
Code List
Site
CL Item
Left Lower Quadrant (LLQ)
CL Item
Left Upper Quadrant (LUQ)
CL Item
Right Lower Quadrant (RLQ)
CL Item
Right Upper Quadrant (RUQ)
CL Item
Pubic Bone (Super Pubic)
C33423 (NCI Thesaurus)
C0034014 (UMLS 2011AA)
CL Item
Umbilicus (Umbilicus)
C77533 (NCI Thesaurus)
C0041638 (UMLS 2011AA)
Item
Ligation Method
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C15270 (NCI Thesaurus Property-2)
C0023690 (UMLS 2011AA Property-2)
C71460 (NCI Thesaurus Property-3)
C0025663 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.15
Code List
Ligation Method
CL Item
Sugical Clip (Clips)
CL Item
Enseal (Enseal)
CL Item
Harmonic Scalpel (Harmonic)
CL Item
Ligasure (Ligasure)
CL Item
Surgical Staple (Staples)
CL Item
Suture Dosage Form (Suture)
C47889 (NCI Thesaurus)
C1706068 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SurgicalProcedureLaparoscopyLigationMethodSpecify
Item
Other specify
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C15270 (NCI Thesaurus Property-2)
C0023690 (UMLS 2011AA Property-2)
C71460 (NCI Thesaurus Property-3)
C0025663 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ValueDomain-2)
Item
TME Dissection Instrument
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C16830 (NCI Thesaurus Property-2)
C0025080 (UMLS 2011AA Property-2)
C16180 (NCI Thesaurus Property-3)
C1273428 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.16
Code List
TME Dissection Instrument
CL Item
Cautery Scissors (Cautery scissors)
CL Item
Enseal (Enseal)
CL Item
Harmonic Scalpel (Harmonic)
CL Item
Hook Cautery (Hook cautery)
CL Item
Ligature (Ligature)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SurgicalProcedureLaparoscopyTotalMesorectalExcisionMedicalDeviceSpecify
Item
Other specify
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C16830 (NCI Thesaurus Property-2)
C0025080 (UMLS 2011AA Property-2)
C16180 (NCI Thesaurus Property-3)
C1273428 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ValueDomain-2)
Item
Low Rectal Transection Stapler Type
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C16830 (NCI Thesaurus Property-2)
C0025080 (UMLS 2011AA Property-2)
C25224 (NCI Thesaurus Property-3)
C0205052 (UMLS 2011AA Property-3)
C15232 (NCI Thesaurus Property-4)
C0728940 (UMLS 2011AA Property-4)
C79082 (NCI Thesaurus Property-5)
C0038938 (UMLS 2011AA Property-5)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.17
Code List
Low Rectal Transection Stapler Type
CL Item
Curvilinear, 45 Mm (Curvilinear, 45 mm)
CL Item
Endo-cutter 30 Mm (Endo-cutter 30 mm)
CL Item
Endo-cutter 45 Mm (Endo-cutter 45 mm)
CL Item
Endo-cutter 60 Mm (Endo-cutter 60 mm)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Power Medical Gia (Power medical GIA)
CL Item
Transverse Linear, 30 Mm (Transverse linear, 30 mm)
CL Item
Transverse Linear, 60 Mm (Transverse linear, 60 mm)
SurgicalProcedureLaparoscopyRectalExcisionSurgicalStaplerMedicalDeviceCount
Item
Number of firing
float
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C16830 (NCI Thesaurus Property-2)
C0025080 (UMLS 2011AA Property-2)
C25224 (NCI Thesaurus Property-3)
C0205052 (UMLS 2011AA Property-3)
C15232 (NCI Thesaurus Property-4)
C0728940 (UMLS 2011AA Property-4)
C79082 (NCI Thesaurus Property-5)
C0038938 (UMLS 2011AA Property-5)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
SurgicalProcedureLaparoscopyRectalExcisionStaplerMedicalDeviceSpecify
Item
Other, specify
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C16830 (NCI Thesaurus Property-2)
C0025080 (UMLS 2011AA Property-2)
C25224 (NCI Thesaurus Property-3)
C0205052 (UMLS 2011AA Property-3)
C15232 (NCI Thesaurus Property-4)
C0728940 (UMLS 2011AA Property-4)
C79082 (NCI Thesaurus Property-5)
C0038938 (UMLS 2011AA Property-5)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Scope Used
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C28167 (NCI Thesaurus Property-3)
C0023036 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.18
Code List
Scope Used
CL Item
Flexible (Flexible)
CL Item
Rigid, 0 Degree (Rigid, 0 degree)
CL Item
Rigid, 30 Degree (Rigid, 30 degree)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SurgicalProcedureLaparoscopeUseSpecify
Item
Other specify
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C28167 (NCI Thesaurus Property-3)
C0023036 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ValueDomain-2)
SurgicalProcedureLaparoscopicPortChangeLocationInd-2
Item
Was a change in ports required
boolean
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25446 (NCI Thesaurus Property-2)
C0392747 (UMLS 2011AA Property-2)
C79080 (NCI Thesaurus Property-3)
C2697883 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
SurgicalProcedureLaparoscopicRetractorsUseTherapyInd-2
Item
Were retractors needed
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C79091 (NCI Thesaurus Property-2)
C2697884 (UMLS 2011AA Property-2)
Item
Type of retractor
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C79091 (NCI Thesaurus Property-2)
C2697884 (UMLS 2011AA Property-2)
CL.21
Code List
Type of retractor
CL Item
10mm Grasper (10mm grasper)
CL Item
5mm Grasper (5mm grasper)
CL Item
Fan Retractor (Fan retractor)
CL Item
Liver Retractor (Liver retractor)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SurgicalProcedureLaparoscopicRetractorsUseSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C79091 (NCI Thesaurus Property-2)
C2697884 (UMLS 2011AA Property-2)
SurgicalProcedureLaparoscopicRetractorOrganPhysicalShiftPresentInd-2
Item
Was there organ displacement
boolean
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C13018 (NCI Thesaurus Property-2)
C0178784 (UMLS 2011AA Property-2)
C73943 (NCI Thesaurus Property-3)
C2347509 (UMLS 2011AA Property-3)
C79091 (NCI Thesaurus Property-4)
C2697884 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Retractor used
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C13018 (NCI Thesaurus Property)
C0178784 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C73943 (NCI Thesaurus Property-3)
C2347509 (UMLS 2011AA Property-3)
C79091 (NCI Thesaurus Property-4)
C2697884 (UMLS 2011AA Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.23
Code List
Retractor used
CL Item
10mm Grasper (10mm grasper)
CL Item
5mm Grasper (5mm grasper)
CL Item
Fan Retractor (Fan retractor)
CL Item
Liver Retractor (Liver retractor)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
SurgicalProcedureLaparoscopicRetractorOrganPhysicalShiftUseSpecify
Item
Other, specify
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C13018 (NCI Thesaurus Property)
C0178784 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C73943 (NCI Thesaurus Property-3)
C2347509 (UMLS 2011AA Property-3)
C79091 (NCI Thesaurus Property-4)
C2697884 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
SurgicalProcedureLaparoscopicSmokeEvacuatorUseInd-2
Item
Was a smoke evacuator used
boolean
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C79092 (NCI Thesaurus Property-3)
C2699315 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
SurgicalProcedureAnastomosisPerformedTherapyInd-2
Item
Anastomosis
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15609 (NCI Thesaurus Property)
C0677554 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
Item
Method used
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15609 (NCI Thesaurus Property)
C0677554 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
CL.26
Code List
Method used
CL Item
Double Stapled End To End (Double stapled end to end)
CL Item
Hand Sewn Coloanal (Hand sewn coloanal)
CL Item
Hand Sewn End To End (Hand sewn end to end)
CL Item
Side To Side Functional End To End (Side to side functional end to end)
CL Item
Single Stapled End To End (Single stapled end to end)
ColorectalSurgicalProcedureExcisionLaparoscopyOpenPerformedInd-2
Item
Was laparoscopic resection converted to open
boolean
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C49069 (NCI Thesaurus Property-4)
C0175566 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Reason laparoscopic resection was converted to open
text
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C49069 (NCI Thesaurus Property-4)
C0175566 (UMLS 2011AA Property-4)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.28
Code List
Reason laparoscopic resection was converted to open
CL Item
Adhesion (Adhesions)
CL Item
Complication/adverse Event During Surgery (Complication/adverse event during surgery)
CL Item
Locally Advanced Disease Discovered At Surgery (Locally advanced disease discovered at surgery)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unable To Complete Anastomosis Safely (Unable to complete anastomosis safely)
CL Item
Unable To Complete Rectal Dissection Safely (Unable to complete rectal dissection safely)
ColorectalSurgicalProcedureExcisionLaparoscopyOpenPerformedSpecify
Item
Other specify
text
C13363 (NCI Thesaurus ObjectClass)
C0555952 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C16969 (NCI Thesaurus Property)
C0031150 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15232 (NCI Thesaurus Property-3)
C0728940 (UMLS 2011AA Property-3)
C49069 (NCI Thesaurus Property-4)
C0175566 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Intra-operative Complications
AdverseEventIntraoperativeComplicationAnatomicSitePresentInd-2
Item
Intra-operative Complications
boolean
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C13717 (NCI Thesaurus Property)
C1515974 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C34735 (NCI Thesaurus Property-3)
C0021890 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Intra-operative Complications
text
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C13717 (NCI Thesaurus Property)
C1515974 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property-2)
C0150312 (UMLS 2011AA Property-2)
C34735 (NCI Thesaurus Property-3)
C0021890 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.30
Code List
Intra-operative Complications
CL Item
Hemorrhage/bleeding Associated With Surgery (Hemorrhage/bleeding associated with surgery)
CL Item
Intra-operative Injury, Other: Air Embolism (Intra-operative injury, other: Air embolism)
CL Item
Intra-operative Injury: Abdomen Nos (Intra-operative injury: Abdomen NOS)
CL Item
Artery Intraoperative Complication (Intra-operative injury: Artery NOS)
C12372 (NCI Thesaurus)
C0003842 (UMLS 2011AA)
C34735 (NCI Thesaurus-3)
C0021890 (UMLS 2011AA-4)
CL Item
Intra-operative Injury: Bladder (Intra-operative injury: Bladder)
CL Item
Intra-operative Injury: Colon (Intra-operative injury: Colon)
CL Item
Intra-operative Injury: Rectum (Intra-operative injury: Rectum)
CL Item
Intra-operative Injury: Small Bowel Nos (Intra-operative injury: Small bowel NOS)
CL Item
Intra-operative Injury: Spleen (Intra-operative injury: Spleen)
CL Item
Gastrointestinal Tract Stoma Intraoperative Complication (Intra-operative injury: Stoma (GI))
C34082 (NCI Thesaurus)
C0017189 (UMLS 2011AA)
C34735 (NCI Thesaurus-3)
C0021890 (UMLS 2011AA-4)
C13345 (NCI Thesaurus-5)
C1955856 (UMLS 2011AA-6)
CL Item
Intra-operative Injury: Ureter (Intra-operative injury: Ureter)
CL Item
Intra-operative Injury: Vein Nos (Intra-operative injury: Vein NOS)
CL Item
Other (Other)
IntrahepaticInfusionProcedureOtherComplicationSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C15731 (NCI Thesaurus ObjectClass)
C1134564 (UMLS 2011AA ObjectClass)
C2959 (NCI Thesaurus Property-2)
C0009566 (UMLS 2011AA Property-2)
Item
Complication due to
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C34735 (NCI Thesaurus Property-2)
C0021890 (UMLS 2011AA Property-2)
CL.31
Code List
Complication due to
CL Item
Grasping (Grasping)
CL Item
Ligation (Ligation)
C15270 (NCI Thesaurus)
C0023690 (UMLS 2011AA)
CL Item
Transection (Transection)
Item Group
Footer Module
Responsible Person Signature
Item
Completed by
text
C25704 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C25678 (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)
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