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