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ID
7481
Description
S1011 Intra-Op Surgical Assessment Form Standard Versus Extended LND (#10689) Standard or Extended Pelvic Lymphadenectomy in Treating Patients Undergoing Surgery for Invasive Bladder Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=940453E3-434E-BBC7-E040-BB89AD431F9F
Lien
Mots-clés
Versions (2)
- 26/08/2012 26/08/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
Téléchargé le
9 janvier 2015
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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Bladder Cancer NCT01224665 Treatment - S1011 Intra-Op Surgical Assessment Form Standard Versus Extended LND (#10689) - 3153877v1.0
Instructions: To be completed by attending surgeon. Please complete post surgery, on the day of surgery. Surgeons should be provided with this form prior to the surgical event. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form
- StudyEvent: S1011 Intra-Op Surgical Assessment Form Standard Versus Extended LND (#10689)
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Instructions: To be completed by attending surgeon. Please complete post surgery, on the day of surgery. Surgeons should be provided with this form prior to the surgical event. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form
- StudyEvent: S1011 Intra-Op Surgical Assessment Form Standard Versus Extended LND (#10689)
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Trial subject ID SWOG
Item
SWOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Protocol ID SWOG
Item
SWOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1519429 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25699 (NCI Thesaurus Property-2)
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Initials
Item
Patient Initials (L, F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
ProtocolSurgeryDate
Item
Protocol Surgery Date (MM DD YYYY)
date
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C0442711 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0543467 (UMLS 2011AA ObjectClass)
C42651 (NCI Thesaurus ObjectClass-2)
C0442711 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Investigator Name
Item
Physician
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
Participating Group
Item
Participating Group Name
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
Intra-operative Extent-of-disease Assessment
BladderCarcinomaTStagePresentInd-2
Item
Clinical T4b (fixed or involvement of pelvic side wall, abdominal wall, or adjacent viscera e.g. colon, small bowel)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C4912 (NCI Thesaurus ObjectClass)
C0699885 (UMLS 2011AA ObjectClass)
C25728 (NCI Thesaurus Property-2)
C0475455 (UMLS 2011AA Property-2)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C4912 (NCI Thesaurus ObjectClass)
C0699885 (UMLS 2011AA ObjectClass)
C25728 (NCI Thesaurus Property-2)
C0475455 (UMLS 2011AA Property-2)
Item
Specify location of tumor (select all that apply)
text
C12414 (NCI Thesaurus ObjectClass)
C0005682 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C12801 (NCI Thesaurus Property-2)
C0040300 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C25408 (NCI Thesaurus Property-4)
C0205117 (UMLS 2011AA Property-4)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C0005682 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C12801 (NCI Thesaurus Property-2)
C0040300 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C25408 (NCI Thesaurus Property-4)
C0205117 (UMLS 2011AA Property-4)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL Item
Pelvic Sidewall (Pelvic sidewall)
CL Item
Abdominal Wall (Abdominal wall)
C77608 (NCI Thesaurus)
C0836916 (UMLS 2011AA)
C0836916 (UMLS 2011AA)
CL Item
Rectosigmoid (Rectosigmoid)
CL Item
Other Specify (Other)
BladderMalignantNeoplasmAdjacentTissueMetastaticInvolvementSpecify
Item
Other specify
text
C12414 (NCI Thesaurus ObjectClass)
C0005682 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C12801 (NCI Thesaurus Property-2)
C0040300 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C25408 (NCI Thesaurus Property-4)
C0205117 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0005682 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C12801 (NCI Thesaurus Property-2)
C0040300 (UMLS 2011AA Property-2)
C25548 (NCI Thesaurus Property-3)
C1314939 (UMLS 2011AA Property-3)
C25408 (NCI Thesaurus Property-4)
C0205117 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
AbnormalLymphNodePresentInd-2
Item
Gross Lymphadenopathy (Note: if in the extended template, must be frozen)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25401 (NCI Thesaurus ObjectClass)
C0205161 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass-2)
C0024204 (UMLS 2011AA ObjectClass-2)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25401 (NCI Thesaurus ObjectClass)
C0205161 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass-2)
C0024204 (UMLS 2011AA ObjectClass-2)
Item
Location of gross lymphadenopathy (Please complete if the answer was "Yes" to Gross Lymphadenopathy. Select all that apply)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus Property)
C0012634 (UMLS 2011AA Property)
C4912 (NCI Thesaurus ObjectClass)
C0699885 (UMLS 2011AA ObjectClass)
C25332 (NCI Thesaurus Property-2)
C0439792 (UMLS 2011AA Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus Property)
C0012634 (UMLS 2011AA Property)
C4912 (NCI Thesaurus ObjectClass)
C0699885 (UMLS 2011AA ObjectClass)
C25332 (NCI Thesaurus Property-2)
C0439792 (UMLS 2011AA Property-2)
Code List
Location of gross lymphadenopathy (Please complete if the answer was "Yes" to Gross Lymphadenopathy. Select all that apply)
CL Item
Above Common Illiac Bifurcation (Above common illiac bifurcation)
CL Item
Below Common Illiac Bifurcation (Below common illiac bifurcation)
Item
Pathologic Lymph Node Assessment (if selected please specify)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)
CL Item
Negative (negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
C0205160 (UMLS 2011AA)
CL Item
Positive (positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
Item Group
Description Of How Nodal Packets Were Submitted To Your Pathologist
ProtocolSurgeryPerformedInd-3
Item
Did the participant have surgery per 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)
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)
SurgeryNotPerformedReason
Item
Reason surgery not performed (If no)
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C0392360 (UMLS 2011AA ValueDomain)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
Item
Extent of pelvic lymph node dissection
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C25399 (NCI Thesaurus ObjectClass-2)
C0030797 (UMLS 2011AA ObjectClass-2)
C0332307 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C25399 (NCI Thesaurus ObjectClass-2)
C0030797 (UMLS 2011AA ObjectClass-2)
CL Item
Protocol Defined Standard (Protocol defined Standard)
CL Item
Extended (Extended)
Item
Cranial extent of dissection (If "Extended,")
text
C4912 (NCI Thesaurus ObjectClass)
C0699885 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C25323 (NCI Thesaurus Property-2)
C0443268 (UMLS 2011AA Property-2)
C25332 (NCI Thesaurus Property-3)
C0439792 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0699885 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C25323 (NCI Thesaurus Property-2)
C0443268 (UMLS 2011AA Property-2)
C25332 (NCI Thesaurus Property-3)
C0439792 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
Aorta Bifurcation (Aortic Bifurcation)
C90367 (NCI Thesaurus)
C12669 (NCI Thesaurus-2)
C0003483 (UMLS 2011AA)
C12669 (NCI Thesaurus-2)
C0003483 (UMLS 2011AA)
CL Item
Between Aortic Bifurcation And Ima (Between Aortic Bifurcation and IMA)
CL Item
Inferior Mesenteric Artery (IMA)
CL Item
Above Inferior Mesenteric Artery (Above IMA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
PatientSurgicalResectionAnatomicSiteSpecify
Item
Specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25698 (NCI Thesaurus Property)
C15232 (NCI Thesaurus Property-2)
C0728940 (UMLS 2011AA Property)
C1521902 (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 Group
Surgical Assessment Of Nodal Dissection
Item
Which lymph node areas were dissected (Please check all that apply Boundaries for "pelvic" are defined by the Standard node dissection)
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C1515974 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
Code List
Which lymph node areas were dissected (Please check all that apply Boundaries for "pelvic" are defined by the Standard node dissection)
CL Item
Right Pelvis (Right pelvic)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
C12767 (NCI Thesaurus-3)
C0030797 (UMLS 2011AA-4)
C0205090 (UMLS 2011AA)
C12767 (NCI Thesaurus-3)
C0030797 (UMLS 2011AA-4)
CL Item
Left Pelvis (Left pelvic)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
C12767 (NCI Thesaurus-3)
C0030797 (UMLS 2011AA-4)
C0205091 (UMLS 2011AA)
C12767 (NCI Thesaurus-3)
C0030797 (UMLS 2011AA-4)
CL Item
Right Obturator (Right obturator)
CL Item
Left Obturator Lymph Node (Left obturator)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
C88141 (NCI Thesaurus-3)
C0205091 (UMLS 2011AA)
C88141 (NCI Thesaurus-3)
CL Item
Right External Iliac (Right external iliac)
CL Item
Left External Iliac Lymph Node (Left external iliac)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
C88143 (NCI Thesaurus-3)
C0205091 (UMLS 2011AA)
C88143 (NCI Thesaurus-3)
CL Item
Right Internal Iliac (Right internal iliac)
CL Item
Left Internal Iliac Lymph Node (Left internal iliac)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
C88142 (NCI Thesaurus-3)
C0205091 (UMLS 2011AA)
C88142 (NCI Thesaurus-3)
CL Item
Paravesical (Paravesical)
CL Item
Right Node Of Cloquet (Right node of cloquet)
CL Item
Left Node Of Cloquet (Left node of cloquet)
CL Item
Right Common Iliac (Right common iliac)
CL Item
Left Common Iliac (Left common iliac)
CL Item
Pre-sacral (Pre-sacral)
CL Item
Right Fossa Of Marcille (Right fossa of Marcille)
CL Item
Left Fossa Of Marcille (Left fossa of Marcille)
CL Item
Aorta (Aortic)
C12669 (NCI Thesaurus)
C0003483 (UMLS 2011AA)
C0003483 (UMLS 2011AA)
CL Item
Pre-aortic (Pre-aortic)
CL Item
Para-aortic (para-aortic)
CL Item
Caval (Caval)
CL Item
Pre-caval (Pre-caval)
CL Item
Para-caval (Para-caval)
CL Item
Other Specify (other)
LymphNodeDissectionSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
Item
Surgical Reconstruction
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)
C0332307 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus Property)
C0524865 (UMLS 2011AA Property)
CL Item
Ileal Conduit (Ileal Conduit)
CL Item
Neobladder (Neobladder)
CL Item
Continent Catheterizable Reservoir (Continent Catheterizable Reservoir)
CL Item
Other, Specify (Other specify)
SurgeryReconstructionSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus Property)
C0524865 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25351 (NCI Thesaurus Property)
C0524865 (UMLS 2011AA Property)
Item
Anastomosis Performed Type
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)
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 Item
Entirely Stapled (Entirely stapled)
CL Item
Hand-sewn (Hand-sewn)
CL Item
Partially Stapled And Partially Hand-sewn (Partially stapled and partially hand-sewn)
Duration of Surgery
Item
Duration of Surgery (skin to skin, in hrs: minutes)
float
C15329 (NCI Thesaurus ObjectClass)
C0488629 (UMLS CUI-1)
C25275 (NCI Thesaurus Property)
C25330 (NCI Thesaurus ValueDomain)
C0488629 (UMLS CUI-1)
C25275 (NCI Thesaurus Property)
C25330 (NCI Thesaurus ValueDomain)
TotalEstimateBloodLossAmount
Item
Estimated blood loss (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)
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)
WholeBloodTransfusionCount
Item
Total units whole blood (in units equivalent to 500 ml whole blood)
float
C0370231 (NCI Metathesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
C15408 (NCI Thesaurus ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
C15408 (NCI Thesaurus ObjectClass)
PackedRedBloodCellTransfusionReceivedUnitCount
Item
Total units PRBC (in units equivalent to 500 ml whole blood)
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)
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)
FreshFrozenPlasmaTransfusionReceivedUnitCount
Item
Total units fresh frozen plasma (in units equivalent to 500 ml whole blood)
float
C0016709 (NCI Metathesaurus ObjectClass)
C15408 (NCI Thesaurus ObjectClass)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C44278 (NCI Thesaurus ValueDomain)
C0439148 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C15408 (NCI Thesaurus ObjectClass)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C44278 (NCI Thesaurus ValueDomain)
C0439148 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
PlateletTransfusionReceivedUnitCount
Item
Total units platelets (in units equivalent to 500 ml whole blood)
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)
C15366 (NCI Thesaurus ObjectClass)
C0086818 (UMLS 2011AA ObjectClass)
C0439148 (UMLS 2011AA ValueDomain)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C15366 (NCI Thesaurus ObjectClass)
C0086818 (UMLS 2011AA ObjectClass)
AdverseEventIntraoperativeComplicationAnatomicSitePresentInd-2
Item
Intraoperative vascular injury
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)
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)
AdverseEventIntraoperativeComplicationOtherAnatomicSitePresentAdverseEventSpecify
Item
Specify location (If yes)
text
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C13717 (NCI Thesaurus Property)
C1515974 (UMLS 2011AA Property)
C17649 (NCI Thesaurus Property-2)
C0205394 (UMLS 2011AA Property-2)
C25626 (NCI Thesaurus Property-3)
C0150312 (UMLS 2011AA Property-3)
C34735 (NCI Thesaurus Property-4)
C0021890 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0877248 (UMLS 2011AA ObjectClass)
C13717 (NCI Thesaurus Property)
C1515974 (UMLS 2011AA Property)
C17649 (NCI Thesaurus Property-2)
C0205394 (UMLS 2011AA Property-2)
C25626 (NCI Thesaurus Property-3)
C0150312 (UMLS 2011AA Property-3)
C34735 (NCI Thesaurus Property-4)
C0021890 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Perioperative DVT prophylaxis (other than sequential compression device)
text
C25284 (NCI Thesaurus ValueDomain)
C0003280 (UMLS CUI-1)
C263 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0003280 (UMLS CUI-1)
C263 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
CL Item
Heparin (Heparin)
C539 (NCI Thesaurus)
C0019134 (UMLS 2011AA)
C0019134 (UMLS 2011AA)
CL Item
Lovenox (Lovenox)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
DVT prevention, specify
Item
Other, specify
text
C49343 (NCI Thesaurus ObjectClass)
C0853245 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass-2)
C15405 (NCI Thesaurus ObjectClass-3)
C25639 (NCI Thesaurus Property)
C1521902 (UMLS CUI-2)
C25685 (NCI Thesaurus ValueDomain)
C0853245 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass-2)
C15405 (NCI Thesaurus ObjectClass-3)
C25639 (NCI Thesaurus Property)
C1521902 (UMLS CUI-2)
C25685 (NCI Thesaurus ValueDomain)
EpiduralAnestheticAgentAdministeredInd-2
Item
Epidural anesthesia employed
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C245 (NCI Thesaurus ObjectClass)
C0002932 (UMLS 2011AA ObjectClass)
C15683 (NCI Thesaurus ObjectClass-2)
C1526986 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C245 (NCI Thesaurus ObjectClass)
C0002932 (UMLS 2011AA ObjectClass)
C15683 (NCI Thesaurus ObjectClass-2)
C1526986 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
NervePreservationSurgicalProcedurePerformedInd-2
Item
Nerve sparing
boolean
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C12466 (NCI Thesaurus ObjectClass-2)
C0027740 (UMLS 2011AA ObjectClass-2)
C52243 (NCI Thesaurus ObjectClass-3)
C0033085 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0543467 (UMLS 2011AA ObjectClass)
C12466 (NCI Thesaurus ObjectClass-2)
C0027740 (UMLS 2011AA ObjectClass-2)
C52243 (NCI Thesaurus ObjectClass-3)
C0033085 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Laterality (Please complete if the answer was "yes" to nerve sparing. Select all that apply)
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C12466 (NCI Thesaurus ObjectClass-2)
C0027740 (UMLS 2011AA ObjectClass-2)
C52243 (NCI Thesaurus ObjectClass-3)
C0033085 (UMLS 2011AA ObjectClass-3)
C25185 (NCI Thesaurus Property)
C0332304 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0543467 (UMLS 2011AA ObjectClass)
C12466 (NCI Thesaurus ObjectClass-2)
C0027740 (UMLS 2011AA ObjectClass-2)
C52243 (NCI Thesaurus ObjectClass-3)
C0033085 (UMLS 2011AA ObjectClass-3)
C25185 (NCI Thesaurus Property)
C0332304 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Laterality (Please complete if the answer was "yes" to nerve sparing. Select all that apply)
CL Item
Left (Left)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
C0205091 (UMLS 2011AA)
CL Item
Right (Right)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
C0205090 (UMLS 2011AA)
Item
Nerve-sparing status (if selected please specify)
text
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C12466 (NCI Thesaurus ObjectClass-2)
C0027740 (UMLS 2011AA ObjectClass-2)
C52243 (NCI Thesaurus ObjectClass-3)
C0033085 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0543467 (UMLS 2011AA ObjectClass)
C12466 (NCI Thesaurus ObjectClass-2)
C0027740 (UMLS 2011AA ObjectClass-2)
C52243 (NCI Thesaurus ObjectClass-3)
C0033085 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL Item
Partial (Partial)
C25378 (NCI Thesaurus)
C0728938 (UMLS 2011AA)
C0728938 (UMLS 2011AA)
CL Item
Complete (Complete)
C25250 (NCI Thesaurus)
C0205197 (UMLS 2011AA)
C0205197 (UMLS 2011AA)
PatientPhotographMalignantNeoplasmAssessmentInd-2
Item
Photographic documentation (required per protocol)
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property-2)
C0006826 (UMLS 2011AA Property)
C86035 (NCI Thesaurus Property-3)
C0441468 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C9305 (NCI Thesaurus Property-2)
C0006826 (UMLS 2011AA Property)
C86035 (NCI Thesaurus Property-3)
C0441468 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
EvaluationNotDoneReasonSpecify
Item
Specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C49484 (NCI Thesaurus Property)
C1272696 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C1521902 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C49484 (NCI Thesaurus Property)
C1272696 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)