ID

7481

Descrição

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

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=940453E3-434E-BBC7-E040-BB89AD431F9F

Palavras-chave

Clinical Trial

Treatment Form

C00-C97.9

C67.9

26/08/2012 26/08/2012 -
09/01/2015 09/01/2015 - Martin Dugas

Transferido a

9 de janeiro de 2015

DOI

Para um pedido faça login.

Licença

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

model
Detalhes

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

1 Formulários

StudyEvent: S1011 Intra-Op Surgical Assessment Form Standard Versus Extended LND (#10689)
1. 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

Name

Tipo

Description | Question | Decode (Coded Value)

Tipo de dados

Alias

Header Module

Item Group

Header

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

INTRA-OPERATIVE EXTENT-OF-DISEASE ASSESSMENT

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)

BladderMalignantNeoplasmAdjacentTissueMetastaticInvolvementSite

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)

CL.2

Code List

Specify location of tumor (select all that apply)

CL Item

Pelvic Sidewall (Pelvic sidewall)

CL Item

Abdominal Wall (Abdominal wall)

C77608 (NCI Thesaurus)
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)

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)

BladderCarcinomaDiseaseExtentType

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)

CL.4

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)

LymphNodePathologicInvolvementType

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)

CL.5

Code List

Pathologic Lymph Node Assessment (if selected please specify)

CL Item

Negative (negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Positive (positive)

C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)

SURGICAL ASSESSMENT OF NODAL DISSECTION

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)

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)

PelvicLymphNodeDissectionType

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)

CL.7

Code List

Extent of pelvic lymph node dissection

CL Item

Protocol Defined Standard (Protocol defined Standard)

CL Item

Extended (Extended)

BladderCarcinomaNodalDissectionExtentType

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)

CL.8

Code List

Cranial extent of dissection (If "Extended,")

CL Item

Aorta Bifurcation (Aortic Bifurcation)

C90367 (NCI Thesaurus)
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)

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)

DESCRIPTION OF HOW NODAL PACKETS WERE SUBMITTED TO YOUR PATHOLOGIST

Item Group

Surgical Assessment Of Nodal Dissection

LymphNodeDissectionAnatomicSite

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)

CL.9

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)

CL Item

Left Pelvis (Left pelvic)

C25229 (NCI Thesaurus)
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)

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)

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)

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)

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)

RECONSTRUCTION

Item Group

Reconstruction

SurgeryReconstructionType

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)

CL.10

Code List

Surgical Reconstruction

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)

SurgicalProcedureAnastomosisPerformedType

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)

CL.11

Code List

Anastomosis Performed Type

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)

OPERATIVE INFORMATION

Item Group

Operative Information

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)

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)

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)

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)

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)

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)

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)

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)

Anticoagulation Drugs

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)

CL.13

Code List

Perioperative DVT prophylaxis (other than sequential compression device)

CL Item

Heparin (Heparin)

C539 (NCI Thesaurus)
C0019134 (UMLS 2011AA)

CL Item

Lovenox (Lovenox)

CL Item

Other (Other)

C17649 (NCI Thesaurus)
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)

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)

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)

NervePreservationSurgicalProcedureLateralityType

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)

CL.16

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)

CL Item

Right (Right)

C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)

NervePreservationSurgicalProcedurePerformedStatus

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)

CL.17

Code List

Nerve-sparing status (if selected please specify)

CL Item

Partial (Partial)

C25378 (NCI Thesaurus)
C0728938 (UMLS 2011AA)

CL Item

Complete (Complete)

C25250 (NCI Thesaurus)
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)

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Item

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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)

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Item Group

Comments

Research Comments

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

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Bladder Cancer NCT01224665 Treatment - S1011 Intra-Op Surgical Assessment Form Standard Versus Extended LND (#10689) - 3153877v1.0

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