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
  2. 1/9/15
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

No Instruction available.

  1. StudyEvent: Z6051 Rectal Surgery Form (RS)
    1. No Instruction available.
Header Module
Visit
Surgery
Did the patient have surgery as part of protocol treatment?
Reason surgery not performed
Surgical Approach
Was an ostomy created at the time of resection?
min
Sphincter preservation planned prior to surgery
cm
Margins examined by frozen section
cm
Rectum intact
Video documentation
Was attempted surgery complete
For Patients Randomized To Laproscopic Surgery Only
Surgical approach
mm
mm
Port Pattern
Hand Port
Site
Ligation Method
TME Dissection Instrument
Low Rectal Transection Stapler Type
Scope Used
Was a change in ports required
Were retractors needed
Type of retractor
Was there organ displacement
Retractor used
Was a smoke evacuator used
Anastomosis
Method used
Was laparoscopic resection converted to open
Reason laparoscopic resection was converted to open
Intra-operative Complications
Intra-operative Complications
Intra-operative Complications
Complication due to
Footer Module

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