MII IG Kerndatensatz-Modul Onkologie
2027.0.0-ballot.1 - Germany

This page is part of the MII IG Kerndatensatz-Modul Onkologie (v2027.0.0-ballot.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example Procedure: Sigmaresektion - Haupteingriff

English

MII EX Onko Operation Intention: Kurativ

status: Completed

category: Surgical procedure

code: Laparoskopische Sigmaresektion mit TME und Lymphknotendissektion

subject: Hans Schmidt Male, DoB: 1959-03-15 ( https://www.medizininformatik-initiative.de/fhir/sid/patienten#FOLFOX-2024-001)

encounter: Encounter: status = finished; class = inpatient encounter (ActCode#IMP)

performed: 2024-02-15

reasonReference: Condition Bösartige Neubildung: Colon sigmoideum

outcome: Kein Residualtumor

note:

Laparoscopic sigmoid resection with TME and lymphadenectomy. No intraoperative complications. Tumor completely resected with clear margins (R0). 18 lymph nodes removed, 3 positive. Surgery performed in 3 components: resection, anastomosis, and lymph node dissection.