Supplementary data . Questionnaire “Association Française de Chirurgie”
Demographic data
Number
Center
Center number
Name (3 first letters)
First name (3 first letters)
Sex (Male/Female)
Maiden name
Date of birth
American society of anaesthesiology score
Comorbidity (Y/N)
Diabetes (Y/N)
Thrombosis (Y/N)
Cardiac disease (Y/N)
Arythmia (Y/N)
Cirrhosis (Y/N)
Renal failure (Y/N)
Cardiac insufficiency (Y/N)
Smoking(Y/N)
Weight (Kg)
Height (cm)
BMI (Kg/m²)
Disease characteristics
Date of diagnosis of primary
Location of primary tumor (Rectum/ Colon)
Resection of primary (Y/N)
Date of surgery
Type of approach (Laparoscopy/Open)
Emergency (Y/N)
Occlusion (Y/N)
Perforation (Y/N)
Hemorraghe (Y/N)
Carcinomatosis (Y/N)
Preoperative CEA (ng/ml)
pT
pN
pM
Neoadjuvant therapy (Y/N)
Type of chemotherapy
Radiotherapy (Y/N)
Adjuvant therapy (Y/N)
Type of chemotherapy
Adjuvant radiotherapy (Y/N)
Number of cycles
Time of occurrence of CLM (Mo)
Date of CLM diagnosis
Number of lesions
Segments involved
CT scanner (Y/N)
MRI (Y/N)
Extrahepatic disease (Y/N)
Location of Extrahep. disease
CEA level
CA 19-9 level
Initial resectability (Y/N)
Preoperative treatment
Preop. Chemotherapy (Y/N)
Number of cycles
Number of lines
Type of chemotherapy
Preoperative treatment (Continued)
Date of first cycle
Date of last cycle
Biliary drainage (Y/N)
Side of drainage (left/right)
Date of drainage
Portal vein embolization (Y/N)
Date of portal vein embolization
Intraoperative data
Date of surgery
Rehepatectomy (Y/N)
Type of approach (Laparoscopy/Open)
Type of incision
Intraoperative ultrasound (Y/N)
Distribution (bilobar/ unilobar)
Maximal tumor size, mm
Missing metastases (Y/N)
Number of missing metastases
Curative procedure (Y/N)
Reasons for non curative resection
Anterior approach (Y/N)
Duration of surgery, min
Pedicle clamping (Y/N)
Duration of clamping, min
Total vascular exclusion (Y/N)
Device use for parenchyma transection
Number of specimen
Description of hepatectomy
Associated procedure (Y/N)
Digestive resection (Y/N)
Radiofrequency ablation (Y/N)
Carcinomatosis resection (Y/N)
Biliodigestive anastomosis (Y/N)
Intrahepatic arterial infusion (Y/N)
Abdominal drainage (Y/N)
Thoracic drainage (Y/N)
Intraoperative transfusion (Y/N)
Number of RBC
Postoperative course
Duration of intensive care unit, days
Nasogastric tube (Y/N)
Duration of hospital stay
Intrahop death
Morbidity (Y/N)
Infectious (Y/N)
Antibiotherapy (Y/N)
Mechanical ventilation (Y/N)
Dindo-Clavien classification
Reintervention (Y/N)
Percutaenous drainage (Y/N)
Date of drainage
Transfusion (Y/N)
Histological findings
Number of tumor size
Maximal tumor size, mm
Minimal resection margin, mm
Complete pathologic response (Y/N)
TRG 1 to 5
Differenciation
Non tumoral liver (NTL) : fibrosis (Y/N)
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Histological findings (Continued)
NTL : sinusoidal obstruction syndrome(SOS) (Y/N)
NTL : Grade of SOS
NTL : Cirrhosis (Y/N)
NTL : Steatosis (Y/N)
Postoperatove oncological management
Adjuvant chemotherapy (Y/N)
Number of cycles
Type of CT
Date of first adjuvant chemotherapy
Follow up
CEA at one postop. month (Y/N)
Date of last news
Status at last follow –up (Y/N)
Cause of death
Relapse (Y/N)
Date of relapse
Location of relapse
Treatment of relapse
Potentially curative treatlement of relapse
Chemotherapy (Y/N)
Radiofrequency (Y/N)
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