Form:GLNE 007 Surgery v9.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 2176)
* 2176Visit code (Go To: 774)
 
Permissible Values (value):BLN1 (1)
 
 BLN2 (2)
* 774Date of surgery (MM/DD/YYYY): (Go To: 423)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 2605)
* 2605Surgery type: (Go To: 2946)
 
Permissible Values (value):Colon cancer (153) (Go To: 2946)
 
 Polyp (211) (Go To: 3145)
 
 Rectal cancer (154) (Go To: 2946)
 
 Other, specify: (97) (Go To: 2606)
* 2606Surgery type (Other, specify): (Go To: 2990)
* 2946Colorectal T-Stage, pathologic: (Go To: 2947)
 
Permissible Values (value):TX (7)
 
 T0 (9)
 
 Tis (10)
 
 T1 (11)
 
 T2 (20)
 
 T3 (30)
 
 T4a (41)
 
 T4b (42)
* 2947Colorectal N-Stage, pathologic: (Go To: 2948)
 
Permissible Values (value):NX (1)
 
 N0 (2)
 
 N1 (10)
 
 N1a (11)
 
 N1b (12)
 
 N1c (13)
 
 N2 (20)
 
 N2a (21)
 
 N2b (22)
* 2948Colorectal M-Stage, pathologic: (Go To: 2949)
 
Permissible Values (value):M0 (2)
 
 M1a (4) (Go To: 2545)
 
 M1b (5) (Go To: 2545)
* 2545Metastasis site: (Go To: 2949)
 
Permissible Values (value):Bone (2)
 
 Brain (3)
 
 Kidney (9)
 
 Liver (10)
 
 Lung (12)
 
 Adrenal gland (13)
 
 Pericardial effusion (14)
 
 Pleural effusion (15)
 
 Other, specify: (97) (Go To: 2570)
 
 Unknown (99)
* 2570Metastasis site (Other, specify): (Go To: 2949)
* 2949AJCC Colorectal Stage Group: (Go To: 3169)
 
Permissible Values (value):0 (1)
 
 I (2)
 
 IIA (3)
 
 IIB (4)
 
 IIC (5)
 
 IIIA (6)
 
 IIIB (7)
 
 IIIC (8)
 
 IV (10)
 
 IVA (11)
 
 IVB (12)
 
 Stage group cannot be assessed (20)
 
 No stage group (90)
* 3169Does the calculated value match the expected value? (Go To: 2990)
 
Permissible Values (value):No (0) (Go To: 3170)
 
 Yes (1)
 
 Unknown (99)
* 3170Match expected comments: (Go To: 2990)
* 3145Colon polyp histology or pathology: (Go To: 4705)
 
Permissible Values (value):Adenoma (1)
 
 Carcinoma in situ (2)
 
 High grade dysplasia (3)
 
 Tubulovillous adenoma (5)
 
 Villous adenoma (6)
 
 Sessile serrated adenoma/polyp (7)
 
 Traditional serrated adenoma (8)
 
 Other, specify: (97) (Go To: 3151)
 
 Unknown (99)
* 3151Colon polyp histology or pathology (Other, specify): (Go To: 4705)
* 4705% villous features: (Go To: 2990)
* 2990Colostomy or ileostomy performed? (Go To: 3024)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 3024Location of lesion (colorectal): (Go To: 3013)
 
Permissible Values (value):CE=Cecum (1)
 
 AC=Ascending (2)
 
 HF=Hepatic flexure (3)
 
 TC=Transverse colon (4)
 
 SF=Splenic flexure (5)
 
 DC=Descending colon (6)
 
 SG=Sigmoid colon (7)
 
 RE =Rectum (8)
 
 U=Unobtainable (9)
 
 Unknown (99)
* 3013Size of the primary lesion (value), cm: (Go To: 3012)
* 3012Description of additional lesions seen: (Go To: 2999)
* 2999Tumor or polyp size (depth), cm: (Go To: 3000)
* 3000Tumor or polyp size (length), cm: (Go To: 3001)
* 3001Tumor or polyp size (width), cm: (Go To: 2983)
* 2983Colorectal surgery: (Go To: 3025)
 
Permissible Values (value):Right hemicolectomy (1)
 
 Left hemicolectomy (2)
 
 Sigmoid resection (3)
 
 Transverse resection (4)
 
 Subtotal colectomy (rectum left in) (5)
 
 Total colectomy (all colon and rectum removed) (6)
 
 Low Anterior Resection (LAR) (7)
 
 Abdominal Perineal Resection (APR) (8)
 
 Transanal excision (9)
 
 Lesion removed without colorectal resection (10)
 
 Other, specify: (97) (Go To: 3152)
* 3152Colorectal surgery (Other, specify): (Go To: 3025)
* 3025MSI test result: (Go To: 1097)
 
Permissible Values (value):MSI stable (1)
 
 MSI unstable (2)
 
 MSI test not performed (3)
 
 Unknown (99)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)