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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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