Table 1. Example of data collection form.
Patient demographics |
Name |
ID code |
Date of birth |
Age |
Gender |
Height (cm) |
Weight (Kg) |
BMI |
…. |
Comorbidities |
Current smoker |
Former smoker |
Pack-year |
Diabetes |
Hypertension |
Cardiovascular diseases |
ECOG performance status |
ASA score |
Symptoms (type; duration…) |
…. |
Other syndromes or paraneoplastic syndromes (type; appropriate classification if any…) |
Previous tumors (yes/no; type…) |
Treatment of previous tumor (CT, RT, surgery…) |
Oncological data (in case of oncological disease) |
CT (yes/no; date…) |
PET-CT (yes/no; date…) |
MRI (yes/no; date…) |
Other radiological and instrumental examinations (type; date; results…) |
Preoperative biopsies (type and date) |
Preoperative diagnosis |
Clinical stage |
Lung functionality (in case of pulmonary surgery) |
FEV1, DLCO, pO2, pCO2… |
Pulmonary scintigraphy |
… |
Pre-operative cardiological evaluation |
Echocardiography |
Stress test |
…. |
Preoperative treatment |
Induction therapy (yes/no; type; number of cycles, in case of neoplastic pathology) |
Antibiotic therapy (type and duration) |
Clinical stage (ycTNM, in case of tumor) |
…. |
Surgical info |
Date of operation |
Type of surgery |
Type of surgical access |
Technique (other surgical info…) |
Duration |
Operator |
Assistant |
Use of advanced materials, sealants, energy devices, etc.… |
Number of drainages |
Intraoperative complications (minors, majors, type…) |
…. |
Postoperative data |
ICU admission (yes/no; number of days…) |
Postoperative complications |
Re-operation |
Hospital stay |
Drainage length |
Postoperative pain and VAS scale |
Outcomes (level of satisfaction, quality of life, effectiveness, cosmetic results etc.) |
… |
Oncological and pathological data (in case of oncological disease) |
Histology |
Stage |
Tumor dimension |
Number of lymph nodes removed (number of positive lymph nodes) |
R-status and site |
Receptor mutations |
…. |
Follow-up data |
Date of follow-up |
Recurrence of disease |
Overall survival |
Long term results (level of satisfaction, quality of life, effectiveness, cosmetic results…) |
Any other type of treatment or surgical re-treatment |
Disease-free survival (for oncological diseases) |
Oncological adjuvant treatment (yes/no; type; duration…) |
… |
BMI, body mass index; ECOG, Eastern Cooperative Oncology Group; ASA, American Society of Anesthesiologists; CT, computed tomography; RT, radiotherapy; PET, positron emission tomography; MRI, magnetic resonance imaging; VAS, Visual Analogue Scale.