Appendix Q1 - COLON

Q.1: COLON

For Cases Diagnosed prior to January 1, 2003

C18.0-C18.9

SURGICAL APPROACH

Code	Description
0	None; no cancer-directed surgery of primary site
1	Endoscopy, NOS Note: Endoscopy procedures include: Colonoscopy; Laparoscopy; Sigmoidoscopy
2		Not image guided
3		Image guided
4	Open, NOS
5		Not assisted by endoscopy
6		Assisted by endoscopy
9	Unknown; not stated; death certificate only

SURGERY OF PRIMARY SITE

Code removal/surgical ablation of single or multiple liver metastases under the data item Surgery of Other Regional Site(s), Distant Site(s) or Distant Lymph Node(s).

Code	Description
00	None; no cancer-directed surgery of primary site
10	Local tumor destruction, NOS Note: without pathology specimen.
11		Photodynamic therapy (PDT)
12		Electrocautery; fulguration Note: Includes use of hot forceps for tumor destruction.
13		Cryosurgery
14		Laser Note: No specimen sent to pathology from this surgical event.
20	Local tumor destruction or excision, NOS Note: with pathology specimen.
21		Photodynamic therapy (PDT)
22		Electrocautery
23		Cryosurgery
24		Laser ablation
25		Laser excision
26		Polypectomy
27		Excisional biopsy Note: Specimen sent to pathology from this surgical event.
Procedures coded 30-31 include, but are not limited to: Appendectomy (for an appendix primary only); Enterocolectomy; Ileocolectomy; Partial colectomy, NOS; Partial resection of transverse colon and flexures; Segmental resection, e.g., cecectomy; Sigmoidectomy
30	Partial colectomy, but less than hemicolectomy
31		Partial colectomy with permanent colostomy (Hartmann's operation) Note: Also code colostomy in the data item Reconstruction/Restoration.
40	Hemicolectomy or greater (but less than total); right or left colectomy Note: A hemicolectomy is the removal of total right or left colon and a portion of transverse colon.
50	Total colectomy Note: Removal of colon from cecum to the rectosigmoid or a portion of the rectum.
60	Total proctocolectomy Note: Commonly used for familial polyposis or polyposis coli.
70	Colectomy or coloproctectomy with an en bloc resection of other organs; pelvic exenteration Note: Code 70 includes any colectomy (partial, hemicolectomy, or total) with an en bloc resection of any other organs. The other organs may be partially or totally removed. Procedures that may be a part of an en bloc resection include, but are not limited to: oophorectomy, partial proctectomy, rectal mucosectomy En bloc resection is the removal of organs in one piece at one time. Note: The creation of ileal reservoir which is a part of a pelvic exenteration must also be coded in the data item Reconstruction/Restoration.
80	Colectomy, NOS
90	Surgery, NOS
99	Unknown if cancer-directed surgery performed; death certificate only

SURGICAL MARGINS

Code	Description
0	All margins grossly and microscopically negative
1	Margins involved, NOS
2		Microscopic involvement
5		Macroscopic involvement
7	Margins not documented
8	No cancer-directed surgery of primary site
9	Unknown whether margins were involved or negative; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The pathology report often describes regional lymph nodes by their anatomic location: colic nodes; mesenteric nodes; peri-\epi-\para-\ colic. Regional lymph nodes differ for each anatomical subsite. The following list identifies the regional lymph nodes for each subsite of the colon:

Site	Subsite
Cecum and appendix	Anterior cecal Ileocolic Posterior cecal Right colic
Ascending colon	Ileocolic Middle colic Right colic
Hepatic flexure	Middle colic Right colic
Transverse colon	Middle colic
Splenic flexure	Inferior mesenteric Middle colic, left colic
Descending colon	Inferior mesenteric Left colic Sigmoid
Sigmoid colon	Inferior mesenteric Sigmoid mesenteric Sigmoidal Superior rectal (hemorrhoidal)

Superior mesenteric, external iliac and common iliac nodes are distant lymph nodes. Code the removal of any of these nodes in the data item Surgery of Other Regional Site(s), Distant Site(s), or Distant Lymph Node(s).

Code	Description
0	No regional lymph nodes removed
1	Regional lymph nodes removed, NOS
9	Unknown; not stated; death certificate only

NUMBER OF REGIONAL LYMPH NODES EXAMINED

Code	Description
00	No regional lymph nodes removed
01	One regional lymph node removed
02	Two regional lymph nodes removed
..
90	Ninety or more regional lymph nodes removed
95	No regional lymph nodes removed but aspiration of regional lymph nodes was performed
96	Regional lymph node removal documented as a sampling and number of lymph nodes unknown/not stated
97	Regional lymph node removal documented as dissection and number of lymph nodes unknown/not stated
98	Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as sampling or dissection
99	Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITE(S), DISTANT SITE(S), OR DISTANT LYMPH NODE(S)

Do not code the incidental removal of appendix, gallbladder, bile ducts, or spleen. Incidental removal is when an organ is removed for a reason unrelated to the malignancy (gallbladder removed for obvious cholelithiasis).

Code	Description
0	None; no surgery to other regional or distant sites
1	Surgery to other sites or nodes, NOS; unknown if regional or distant
2		Removal of other regional sites, only
3		Removal/surgical ablation of single liver metastasis
4		Removal/surgical ablation of multiple liver metastases
5		Combination of codes 2 and 3 or 2 and 4
6		Removal of other distant sites or distant lymph nodes, only
7		Combination of code 6 with 3 or 5
8		Combination of code 6 with 4
9	Unknown; not stated; death certificate only

RECONSTRUCTION/RESTORATION - FIRST COURSE

Do not code anastomosis as reconstruction.

Code	Description
0	No reconstruction/restoration
1	Colostomy (permanent)
2	Ileostomy, NOS
3		Without a reservoir or pouch
4		With an abdominal reservoir or pouch
5		With an anal reservoir or pouch; artificial sphincter
9	Unknown; not stated; death certificate only

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