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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