Surgery - XML Representation - IDEA4RC FHIR Implementation Guide v0.1.0

IDEA4RC FHIR Implementation Guide, published by IDEA4RC Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/idea4rc/ and changes regularly. See the Directory of published versions
Logical Model: SurgeryI4RC - XML Profile

Draft as of 2025-07-25
XML representation of the Surgery logical model.
Raw xml | Download

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="Surgery"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition Surgery</b></p><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description &amp; Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery" title="Surgery
Maturity Level: 0 Draft">Surgery</a><a name="Surgery"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://build.fhir.org/types.html#Base">Base</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgery</td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.diagnosisReference" title="Diagnosis reference in case the treatment was done for baseline ">diagnosisReference</a><a name="Surgery.diagnosisReference"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="StructureDefinition-Diagnosis.html">Diagnosis</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Diagnosis reference (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.episodeEventReference" title="EpisodeEvent element containing the data regarding the patient's cancer, in case the treatment was done for an episode event (progression, recurrence...) ">episodeEventReference</a><a name="Surgery.episodeEventReference"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="StructureDefinition-EpisodeEvent.html">EpisodeEvent</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Episode Event reference (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgeryType" title="Primary surgery/re-excision (check with unplanned or excisional biopsy)

Check

&quot;Surgery (with date) is a procedure occurrence, which is 
referred to in the EPISODE_EVENT table. 
Provider of the procedure can be defined based on the hospital.

If type of surgery is not specified use SURGICAL PROCEDURE.&quot;

CHILDREN">surgeryType</a><a name="Surgery.surgeryType"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgery type (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgeryHospital" title="Whether or not a surgical procedure was performed and whether it was performed at the registering hospital or another hospital. Diagnostic procedures (biopsy) are not included. ">surgeryHospital</a><a name="Surgery.surgeryHospital"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#string">string</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgery Hospital (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.dateOfSurgery" title="Date of the surgery for primary tumor with or without neck surgery 
Is there a new excision surgery to treat the cancer by removing the tumor ?
Yes : New event
Is the tumor that is going to be removed metastatic ?
Yes: Add True for Surgery on M, with the same date than the surgery date
Is the tumor on the Neck ?
Yes: add true for Neck Surgery, with the same date than the surgery date
Is the neck surgery accompanied by a dissection ?
Yes : fill the type of dissection">dateOfSurgery</a><a name="Surgery.dateOfSurgery"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of surgery (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgeryIntention" title="Palliative: surgery performed with the intent of improving quality of life or relieving symptoms caused by advanced disease.
Curative: surgery performed with the intend of oncologic cure, regardless of its result (R0 / R1/R2) ">surgeryIntention</a><a name="Surgery.surgeryIntention"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgery intention (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.typeOfSurgicalApproachOnTumour" title="Describes the approach to tumor resection whether it includes skin incision (extenal or open ),  or it 's aproached through a natural orifice (Transnasal/transorbital/transoral) or if the approach combines two or more of the previous ones 
Maybe should be a flag">typeOfSurgicalApproachOnTumour</a><a name="Surgery.typeOfSurgicalApproachOnTumour"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Type of surgical approach on Tumour (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.marginsAfterSurgery" title="The R0 (“no residual rumor”) category applies only to cases in which residual tumor cannot be detected by conventional diagnostic methods. A more exact definition would read “no detectable residual tumor.”This category corresponds to surgical resection for cure.
The R1 category is reserved exclusively for cases in which residual tumor is found by histologic examination. This category may apply to biopsy sampling of the regional tissue at the site of resection or of a distant site at the time of surgery. It also applies to microscopic examination of the resection margins of the surgical resection specimen by the pathologist.
R2 applies to cases with macroscopically visible residual tumor that is detected either clinically or pathologically. ">marginsAfterSurgery</a><a name="Surgery.marginsAfterSurgery"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Margins after surgery (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.tumorRupture" title="Tumor rupture Yes/No 
Cancer modifiers (associated with diagnosis)

For Absence use value_as_concept_id = ABSENT">tumorRupture</a><a name="Surgery.tumorRupture"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Tumor rupture (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.extraNodalExtension" title="Describes the presence or absence of radiological signs of extracapsular extension by histopathologic examination or not, as defined in the AJCC 8th Ed. It's also present in the Clinical/Pathological stages for baseline diagnosis. 
check CODEs">extraNodalExtension</a><a name="Surgery.extraNodalExtension"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Extra-nodal extension (rEne) (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgicalSpecimenMitoticCount" title="Surgical specimen Mitotic count ">surgicalSpecimenMitoticCount</a><a name="Surgery.surgicalSpecimenMitoticCount"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#Quantity">Quantity</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgical specimen Mitotic count (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours" title="Provides the grading for surgical specimen only for untreated tumours ">surgicalSpecimenGradingOnlyInUntreatedTumours</a><a name="Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgical specimen grading only in untreated tumours (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-sarcoma-i4rc.html">Sarcoma</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.reconstruction" title="Local flap / regional pedicled flap / free flap ">reconstruction</a><a name="Surgery.reconstruction"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Reconstruction (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.neckSurgery" title="Describes whether a surgical procedure to treat and address the neck was performed or not. ">neckSurgery</a><a name="Surgery.neckSurgery"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Neck surgery (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.dateOfNeckSurgery" title="Date of the surgery on the neck ">dateOfNeckSurgery</a><a name="Surgery.dateOfNeckSurgery"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of Neck surgery (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.lateralityOfTheDissection" title="Describes laterality of the neck surgical procedure: 
Ipsilateral when only  the neck ipsilateral to the tumor has been treated
Contralateral when only the neck contralateral to the tumor has been treated 
Bilateral: when both sides of the neck have been treated ">lateralityOfTheDissection</a><a name="Surgery.lateralityOfTheDissection"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Laterality of the dissection (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgeryOnM" title="Describes whether surgery is performed to treat the Metastasis ">surgeryOnM</a><a name="Surgery.surgeryOnM"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgery on M (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.dateOfSurgeryOnM" title="Date of the surgery on the metastasis ">dateOfSurgeryOnM</a><a name="Surgery.dateOfSurgeryOnM"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Date of surgery on M (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis" title="Describes if site of surgery on metastasis">siteOfSurgeryOnMetastasis</a><a name="Surgery.siteOfSurgeryOnMetastasis"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.softTissue" title="Describes if site of surgery on metastasis  is soft tissue ">softTissue</a><a name="Surgery.siteOfSurgeryOnMetastasis.softTissue"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_soft tissue (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes" title="Describes if site of surgery on metastasis  is dystan lymph node ">distantLymphNodes</a><a name="Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_distant lymph nodes (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.lung" title="Describes if site of surgery on metastasis  is lung ">lung</a><a name="Surgery.siteOfSurgeryOnMetastasis.lung"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_lung (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.bone" title="Describes if site of surgery on metastasis  is bone ">bone</a><a name="Surgery.siteOfSurgeryOnMetastasis.bone"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_bone (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.liver" title="Describes if site of surgery on metastasis  is liver ">liver</a><a name="Surgery.siteOfSurgeryOnMetastasis.liver"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_liver (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.pleura" title="Describes if site of surgery on metastasis  is pleura ">pleura</a><a name="Surgery.siteOfSurgeryOnMetastasis.pleura"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_pleura (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.peritoneum" title="Describes if site of surgery on metastasis  is peritoneum ">peritoneum</a><a name="Surgery.siteOfSurgeryOnMetastasis.peritoneum"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_peritoneum (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.brain" title="Describes if site of surgery on metastasis  is brain ">brain</a><a name="Surgery.siteOfSurgeryOnMetastasis.brain"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_brain (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.otherViscera" title="Describes if site of surgery on metastasis  is other viscera 
Use the generic metastasis code or a metastasis subsumed in it, 36769180">otherViscera</a><a name="Surgery.siteOfSurgeryOnMetastasis.otherViscera"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_other viscera (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.siteOfSurgeryOnMetastasis.unknown" title="Describes if site of surgery on metastasis  is unknown ">unknown</a><a name="Surgery.siteOfSurgeryOnMetastasis.unknown"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Site of surgery on metastasis_unknown (O)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: white; background-color: inherit" title="Data Type" class="hierarchy"/> <a href="StructureDefinition-Surgery-definitions.html#Surgery.surgicalComplications" title="Describes presence and grade of complications after a surgical procedure, ">surgicalComplications</a><a name="Surgery.surgicalComplications"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="padding-left: 3px; padding-right: 3px; color: white; background-color: red" title="This element has obligations">O</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Surgical complications (Clavien-Dindo Classification) (M)<br/><table class="obligation grid"><tr><td style="font-size: 11px"><b>Obligations</b></td><td style="font-size: 11px"><b>Actor</b></td></tr><tr><td style="font-size: 11px"><b>SHALL</b>:<a href="http://hl7.org/fhir/extensions/5.2.0/CodeSystem-obligation.html#obligation-handle" title="Obligation Codes: correctly handle">handle</a></td><td style="font-size: 11px; opacity: 0.5;"><a href="ActorDefinition-actor-headneck-i4rc.html">Head and Neck</a></td></tr></table></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
  </text>
  <url value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery"/>
  <version value="0.1.0"/>
  <name value="SurgeryI4RC"/>
  <title value="Surgery"/>
  <status value="draft"/>
  <date value="2025-07-25T13:48:09+00:00"/>
  <publisher value="IDEA4RC Project"/>
  <contact>
    <name value="IDEA4RC Project"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.idea4rc.eu/"/>
    </telecom>
  </contact>
  <contact>
    <name value="IDEA4RC Project"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.idea4rc.eu/"/>
    </telecom>
  </contact>
  <description value="Surgery
Maturity Level: 0 Draft"/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="150"/>
      <display value="Europe"/>
    </coding>
  </jurisdiction>
  <fhirVersion value="4.0.1"/>
  <kind value="logical"/>
  <abstract value="false"/>
  <type value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery"/>
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Base"/>
  <derivation value="specialization"/>
  <snapshot>
    <extension
               url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
      <valueString value="4.0.1"/>
    </extension>
    <element id="Surgery">
      <path value="Surgery"/>
      <short value="Surgery"/>
      <definition value="Surgery
Maturity Level: 0 Draft"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Base"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <isModifier value="false"/>
    </element>
    <element id="Surgery.diagnosisReference">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.diagnosisReference"/>
      <short value="Diagnosis reference (M)"/>
      <definition
                  value="Diagnosis reference in case the treatment was done for baseline"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.diagnosisReference"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Diagnosis"/>
      </type>
    </element>
    <element id="Surgery.episodeEventReference">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.episodeEventReference"/>
      <short value="Episode Event reference (M)"/>
      <definition
                  value="EpisodeEvent element containing the data regarding the patient's cancer, in case the treatment was done for an episode event (progression, recurrence...)"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.episodeEventReference"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent"/>
      </type>
    </element>
    <element id="Surgery.surgeryType">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryType"/>
      <short value="Surgery type (M)"/>
      <definition
                  value="Primary surgery/re-excision (check with unplanned or excisional biopsy)

Check

&quot;Surgery (with date) is a procedure occurrence, which is 
referred to in the EPISODE_EVENT table. 
Provider of the procedure can be defined based on the hospital.

If type of surgery is not specified use SURGICAL PROCEDURE.&quot;

CHILDREN"/>
      <comment
               value="Surgical procedure - 4301351
Local excision - 4315400
Amputation - 4217482
Limb operation - 4181193"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgeryType"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.surgeryHospital">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryHospital"/>
      <short value="Surgery Hospital (M)"/>
      <definition
                  value="Whether or not a surgical procedure was performed and whether it was performed at the registering hospital or another hospital. Diagnostic procedures (biopsy) are not included."/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgeryHospital"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element id="Surgery.dateOfSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.dateOfSurgery"/>
      <short value="Date of surgery (M)"/>
      <definition
                  value="Date of the surgery for primary tumor with or without neck surgery 
Is there a new excision surgery to treat the cancer by removing the tumor ?
Yes : New event
Is the tumor that is going to be removed metastatic ?
Yes: Add True for Surgery on M, with the same date than the surgery date
Is the tumor on the Neck ?
Yes: add true for Neck Surgery, with the same date than the surgery date
Is the neck surgery accompanied by a dissection ?
Yes : fill the type of dissection"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.dateOfSurgery"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="Surgery.surgeryIntention">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryIntention"/>
      <short value="Surgery intention (O)"/>
      <definition
                  value="Palliative: surgery performed with the intent of improving quality of life or relieving symptoms caused by advanced disease.
Curative: surgery performed with the intend of oncologic cure, regardless of its result (R0 / R1/R2)"/>
      <comment
               value="Palliative - 4179711
Curative procedure intent - 4162591"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgeryIntention"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.typeOfSurgicalApproachOnTumour">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.typeOfSurgicalApproachOnTumour"/>
      <short value="Type of surgical approach on Tumour (M)"/>
      <definition
                  value="Describes the approach to tumor resection whether it includes skin incision (extenal or open ),  or it 's aproached through a natural orifice (Transnasal/transorbital/transoral) or if the approach combines two or more of the previous ones 
Maybe should be a flag"/>
      <comment
               value="External/Open - 4236080
Transnasal - 4050374
Transorbital - 4044897
Transoral - 4038679
Craniofacial - 4333339
Combined surgical approach - 2000100027"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.typeOfSurgicalApproachOnTumour"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.marginsAfterSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.marginsAfterSurgery"/>
      <short value="Margins after surgery (M)"/>
      <definition
                  value="The R0 (“no residual rumor”) category applies only to cases in which residual tumor cannot be detected by conventional diagnostic methods. A more exact definition would read “no detectable residual tumor.”This category corresponds to surgical resection for cure.
The R1 category is reserved exclusively for cases in which residual tumor is found by histologic examination. This category may apply to biopsy sampling of the regional tissue at the site of resection or of a distant site at the time of surgery. It also applies to microscopic examination of the resection margins of the surgical resection specimen by the pathologist.
R2 applies to cases with macroscopically visible residual tumor that is detected either clinically or pathologically."/>
      <comment
               value="R0: No residual tumor - 1634643
R1: Microscopic residual tumor - 1633801
R2: Macroscopic residual tumor - 1634484"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.marginsAfterSurgery"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.tumorRupture">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.tumorRupture"/>
      <short value="Tumor rupture (M)"/>
      <definition
                  value="Tumor rupture Yes/No 
Cancer modifiers (associated with diagnosis)

For Absence use value_as_concept_id = ABSENT"/>
      <comment value="Tumor Rupture - 36768904"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.tumorRupture"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.extraNodalExtension">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.extraNodalExtension"/>
      <short value="Extra-nodal extension (rEne) (M)"/>
      <definition
                  value="Describes the presence or absence of radiological signs of extracapsular extension by histopathologic examination or not, as defined in the AJCC 8th Ed. It's also present in the Clinical/Pathological stages for baseline diagnosis. 
check CODEs"/>
      <comment value="ENE- - 36769946
ENE+ - 36770618"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.extraNodalExtension"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.surgicalSpecimenMitoticCount">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgicalSpecimenMitoticCount"/>
      <short value="Surgical specimen Mitotic count (M)"/>
      <definition value="Surgical specimen Mitotic count"/>
      <comment value="Number of mitoses per 10 high power fields - 4227243"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgicalSpecimenMitoticCount"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Quantity"/>
      </type>
    </element>
    <element id="Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours"/>
      <short value="Surgical specimen grading only in untreated tumours (M)"/>
      <definition
                  value="Provides the grading for surgical specimen only for untreated tumours"/>
      <comment
               value="Grade-1 - 1634371
Grade-2 - 1634752
Grade-3 - 1633749
Grade-H - 1635587
Grade-L - 1634085"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.reconstruction">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.reconstruction"/>
      <short value="Reconstruction (M)"/>
      <definition value="Local flap / regional pedicled flap / free flap"/>
      <comment value="Yes - 4188539
No -  4188540"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.reconstruction"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.neckSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.neckSurgery"/>
      <short value="Neck surgery (M)"/>
      <definition
                  value="Describes whether a surgical procedure to treat and address the neck was performed or not."/>
      <comment value="Yes - 4188539
No -  4188540"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.neckSurgery"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.dateOfNeckSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.dateOfNeckSurgery"/>
      <short value="Date of Neck surgery (M)"/>
      <definition value="Date of the surgery on the neck"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.dateOfNeckSurgery"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="Surgery.lateralityOfTheDissection">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.lateralityOfTheDissection"/>
      <short value="Laterality of the dissection (M)"/>
      <definition
                  value="Describes laterality of the neck surgical procedure: 
Ipsilateral when only  the neck ipsilateral to the tumor has been treated
Contralateral when only the neck contralateral to the tumor has been treated 
Bilateral: when both sides of the neck have been treated"/>
      <comment
               value="Ipsilateral - 4112106
Bilateral Sampling - 4117496
Controlateral - 4112107"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.lateralityOfTheDissection"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.surgeryOnM">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryOnM"/>
      <short value="Surgery on M (M)"/>
      <definition
                  value="Describes whether surgery is performed to treat the Metastasis"/>
      <comment value="Yes - 4188539
No -  4188540"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgeryOnM"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.dateOfSurgeryOnM">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.dateOfSurgeryOnM"/>
      <short value="Date of surgery on M (M)"/>
      <definition value="Date of the surgery on the metastasis"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.dateOfSurgeryOnM"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis"/>
      <short value="Site of surgery on metastasis"/>
      <definition value="Describes if site of surgery on metastasis"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression
                    value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.id">
      <path value="Surgery.siteOfSurgeryOnMetastasis.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/>
        </extension>
        <code value="http://hl7.org/fhirpath/System.String"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.extension">
      <path value="Surgery.siteOfSurgeryOnMetastasis.extension"/>
      <slicing>
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <description value="Extensions are always sliced by (at least) url"/>
        <rules value="open"/>
      </slicing>
      <short value="Additional content defined by implementations"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <comment
               value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression
                    value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <constraint>
        <key value="ext-1"/>
        <severity value="error"/>
        <human value="Must have either extensions or value[x], not both"/>
        <expression value="extension.exists() != value.exists()"/>
        <xpath
               value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.modifierExtension">
      <path value="Surgery.siteOfSurgeryOnMetastasis.modifierExtension"/>
      <short value="Extensions that cannot be ignored even if unrecognized"/>
      <definition
                  value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <comment
               value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="BackboneElement.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression
                    value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
      </constraint>
      <constraint>
        <key value="ext-1"/>
        <severity value="error"/>
        <human value="Must have either extensions or value[x], not both"/>
        <expression value="extension.exists() != value.exists()"/>
        <xpath
               value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
        <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
      </constraint>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.softTissue">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.softTissue"/>
      <short value="Site of surgery on metastasis_soft tissue (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is soft tissue"/>
      <comment value="Metastasis to soft tissues - 35225724"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.softTissue"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes"/>
      <short value="Site of surgery on metastasis_distant lymph nodes (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is dystan lymph node"/>
      <comment value="Distant spread to lymph node - 36769243"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.lung">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.lung"/>
      <short value="Site of surgery on metastasis_lung (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is lung"/>
      <comment value="Metastasis to lung - 36770283"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.lung"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.bone">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.bone"/>
      <short value="Site of surgery on metastasis_bone (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is bone"/>
      <comment value="Metastasis to bone - 36769301"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.bone"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.liver">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.liver"/>
      <short value="Site of surgery on metastasis_liver (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is liver"/>
      <comment value="Metastasis to liver - 36770544"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.liver"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.pleura">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.pleura"/>
      <short value="Site of surgery on metastasis_pleura (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is pleura"/>
      <comment value="Metastasis to pleura - 35226258"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.pleura"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.peritoneum">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.peritoneum"/>
      <short value="Site of surgery on metastasis_peritoneum (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is peritoneum"/>
      <comment value="Metastasis to peritoneum - 35226253"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.peritoneum"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.brain">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.brain"/>
      <short value="Site of surgery on metastasis_brain (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is brain"/>
      <comment value="Metastasis to brain - 36768862"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.brain"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.otherViscera">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.otherViscera"/>
      <short value="Site of surgery on metastasis_other viscera (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is other viscera 
Use the generic metastasis code or a metastasis subsumed in it, 36769180"/>
      <comment value="Metastasis - 36769180"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.otherViscera"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.unknown">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.unknown"/>
      <short value="Site of surgery on metastasis_unknown (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is unknown"/>
      <comment value="Unknown - 4129922"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Surgery.siteOfSurgeryOnMetastasis.unknown"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.surgicalComplications">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-source">
          <valueUri
                    value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Surgery|0.1.0"/>
        </extension>
      </extension>
      <path value="Surgery.surgicalComplications"/>
      <short
             value="Surgical complications (Clavien-Dindo Classification) (M)"/>
      <definition
                  value="Describes presence and grade of complications after a surgical procedure,"/>
      <comment
               value="Absent - 4132135
Clavien-Dindo complication scale: Grade I - 715974
Clavien-Dindo complication scale: Grade II - 715975
Clavien-Dindo complication scale: Grade III - 715976
Clavien-Dindo complication scale: Grade IIIA - 715977
Clavien-Dindo complication scale: Grade IIIB - 715978
Clavien-Dindo complication scale: Grade IV - 715979
Clavien-Dindo complication scale: Grade IVA - 715980
Clavien-Dindo complication scale: Grade IVB - 715981
Clavien-Dindo complication scale: Grade V - 715982"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="Surgery.surgicalComplications"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
  </snapshot>
  <differential>
    <element id="Surgery">
      <path value="Surgery"/>
      <short value="Surgery"/>
      <definition value="Surgery
Maturity Level: 0 Draft"/>
    </element>
    <element id="Surgery.diagnosisReference">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.diagnosisReference"/>
      <short value="Diagnosis reference (M)"/>
      <definition
                  value="Diagnosis reference in case the treatment was done for baseline "/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Diagnosis"/>
      </type>
    </element>
    <element id="Surgery.episodeEventReference">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.episodeEventReference"/>
      <short value="Episode Event reference (M)"/>
      <definition
                  value="EpisodeEvent element containing the data regarding the patient's cancer, in case the treatment was done for an episode event (progression, recurrence...) "/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code
              value="http://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent"/>
      </type>
    </element>
    <element id="Surgery.surgeryType">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryType"/>
      <short value="Surgery type (M)"/>
      <definition
                  value="Primary surgery/re-excision (check with unplanned or excisional biopsy)

Check

&quot;Surgery (with date) is a procedure occurrence, which is 
referred to in the EPISODE_EVENT table. 
Provider of the procedure can be defined based on the hospital.

If type of surgery is not specified use SURGICAL PROCEDURE.&quot;

CHILDREN"/>
      <comment
               value="Surgical procedure - 4301351
Local excision - 4315400
Amputation - 4217482
Limb operation - 4181193"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.surgeryHospital">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryHospital"/>
      <short value="Surgery Hospital (M)"/>
      <definition
                  value="Whether or not a surgical procedure was performed and whether it was performed at the registering hospital or another hospital. Diagnostic procedures (biopsy) are not included. "/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element id="Surgery.dateOfSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.dateOfSurgery"/>
      <short value="Date of surgery (M)"/>
      <definition
                  value="Date of the surgery for primary tumor with or without neck surgery 
Is there a new excision surgery to treat the cancer by removing the tumor ?
Yes : New event
Is the tumor that is going to be removed metastatic ?
Yes: Add True for Surgery on M, with the same date than the surgery date
Is the tumor on the Neck ?
Yes: add true for Neck Surgery, with the same date than the surgery date
Is the neck surgery accompanied by a dissection ?
Yes : fill the type of dissection"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="Surgery.surgeryIntention">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryIntention"/>
      <short value="Surgery intention (O)"/>
      <definition
                  value="Palliative: surgery performed with the intent of improving quality of life or relieving symptoms caused by advanced disease.
Curative: surgery performed with the intend of oncologic cure, regardless of its result (R0 / R1/R2) "/>
      <comment
               value="Palliative - 4179711
Curative procedure intent - 4162591"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.typeOfSurgicalApproachOnTumour">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.typeOfSurgicalApproachOnTumour"/>
      <short value="Type of surgical approach on Tumour (M)"/>
      <definition
                  value="Describes the approach to tumor resection whether it includes skin incision (extenal or open ),  or it 's aproached through a natural orifice (Transnasal/transorbital/transoral) or if the approach combines two or more of the previous ones 
Maybe should be a flag"/>
      <comment
               value="External/Open - 4236080
Transnasal - 4050374
Transorbital - 4044897
Transoral - 4038679
Craniofacial - 4333339
Combined surgical approach - 2000100027"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.marginsAfterSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.marginsAfterSurgery"/>
      <short value="Margins after surgery (M)"/>
      <definition
                  value="The R0 (“no residual rumor”) category applies only to cases in which residual tumor cannot be detected by conventional diagnostic methods. A more exact definition would read “no detectable residual tumor.”This category corresponds to surgical resection for cure.
The R1 category is reserved exclusively for cases in which residual tumor is found by histologic examination. This category may apply to biopsy sampling of the regional tissue at the site of resection or of a distant site at the time of surgery. It also applies to microscopic examination of the resection margins of the surgical resection specimen by the pathologist.
R2 applies to cases with macroscopically visible residual tumor that is detected either clinically or pathologically. "/>
      <comment
               value="R0: No residual tumor - 1634643
R1: Microscopic residual tumor - 1633801
R2: Macroscopic residual tumor - 1634484"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.tumorRupture">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.tumorRupture"/>
      <short value="Tumor rupture (M)"/>
      <definition
                  value="Tumor rupture Yes/No 
Cancer modifiers (associated with diagnosis)

For Absence use value_as_concept_id = ABSENT"/>
      <comment value="Tumor Rupture - 36768904"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.extraNodalExtension">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.extraNodalExtension"/>
      <short value="Extra-nodal extension (rEne) (M)"/>
      <definition
                  value="Describes the presence or absence of radiological signs of extracapsular extension by histopathologic examination or not, as defined in the AJCC 8th Ed. It's also present in the Clinical/Pathological stages for baseline diagnosis. 
check CODEs"/>
      <comment value="ENE- - 36769946
ENE+ - 36770618"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.surgicalSpecimenMitoticCount">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgicalSpecimenMitoticCount"/>
      <short value="Surgical specimen Mitotic count (M)"/>
      <definition value="Surgical specimen Mitotic count "/>
      <comment value="Number of mitoses per 10 high power fields - 4227243"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="Quantity"/>
      </type>
    </element>
    <element id="Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-sarcoma-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgicalSpecimenGradingOnlyInUntreatedTumours"/>
      <short value="Surgical specimen grading only in untreated tumours (M)"/>
      <definition
                  value="Provides the grading for surgical specimen only for untreated tumours "/>
      <comment
               value="Grade-1 - 1634371
Grade-2 - 1634752
Grade-3 - 1633749
Grade-H - 1635587
Grade-L - 1634085"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.reconstruction">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.reconstruction"/>
      <short value="Reconstruction (M)"/>
      <definition value="Local flap / regional pedicled flap / free flap "/>
      <comment value="Yes - 4188539
No -  4188540"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.neckSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.neckSurgery"/>
      <short value="Neck surgery (M)"/>
      <definition
                  value="Describes whether a surgical procedure to treat and address the neck was performed or not. "/>
      <comment value="Yes - 4188539
No -  4188540"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.dateOfNeckSurgery">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.dateOfNeckSurgery"/>
      <short value="Date of Neck surgery (M)"/>
      <definition value="Date of the surgery on the neck "/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="Surgery.lateralityOfTheDissection">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.lateralityOfTheDissection"/>
      <short value="Laterality of the dissection (M)"/>
      <definition
                  value="Describes laterality of the neck surgical procedure: 
Ipsilateral when only  the neck ipsilateral to the tumor has been treated
Contralateral when only the neck contralateral to the tumor has been treated 
Bilateral: when both sides of the neck have been treated "/>
      <comment
               value="Ipsilateral - 4112106
Bilateral Sampling - 4117496
Controlateral - 4112107"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
    <element id="Surgery.surgeryOnM">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgeryOnM"/>
      <short value="Surgery on M (M)"/>
      <definition
                  value="Describes whether surgery is performed to treat the Metastasis "/>
      <comment value="Yes - 4188539
No -  4188540"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.dateOfSurgeryOnM">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.dateOfSurgeryOnM"/>
      <short value="Date of surgery on M (M)"/>
      <definition value="Date of the surgery on the metastasis "/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="date"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis"/>
      <short value="Site of surgery on metastasis"/>
      <definition value="Describes if site of surgery on metastasis"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="BackboneElement"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.softTissue">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.softTissue"/>
      <short value="Site of surgery on metastasis_soft tissue (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is soft tissue "/>
      <comment value="Metastasis to soft tissues - 35225724"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.distantLymphNodes"/>
      <short value="Site of surgery on metastasis_distant lymph nodes (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is dystan lymph node "/>
      <comment value="Distant spread to lymph node - 36769243"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.lung">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.lung"/>
      <short value="Site of surgery on metastasis_lung (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is lung "/>
      <comment value="Metastasis to lung - 36770283"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.bone">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.bone"/>
      <short value="Site of surgery on metastasis_bone (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is bone "/>
      <comment value="Metastasis to bone - 36769301"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.liver">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.liver"/>
      <short value="Site of surgery on metastasis_liver (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is liver "/>
      <comment value="Metastasis to liver - 36770544"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.pleura">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.pleura"/>
      <short value="Site of surgery on metastasis_pleura (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is pleura "/>
      <comment value="Metastasis to pleura - 35226258"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.peritoneum">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.peritoneum"/>
      <short value="Site of surgery on metastasis_peritoneum (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is peritoneum "/>
      <comment value="Metastasis to peritoneum - 35226253"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.brain">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.brain"/>
      <short value="Site of surgery on metastasis_brain (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is brain "/>
      <comment value="Metastasis to brain - 36768862"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.otherViscera">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.otherViscera"/>
      <short value="Site of surgery on metastasis_other viscera (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is other viscera 
Use the generic metastasis code or a metastasis subsumed in it, 36769180"/>
      <comment value="Metastasis - 36769180"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.siteOfSurgeryOnMetastasis.unknown">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.siteOfSurgeryOnMetastasis.unknown"/>
      <short value="Site of surgery on metastasis_unknown (O)"/>
      <definition
                  value="Describes if site of surgery on metastasis  is unknown "/>
      <comment value="Unknown - 4129922"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="boolean"/>
      </type>
    </element>
    <element id="Surgery.surgicalComplications">
      <extension url="http://hl7.org/fhir/StructureDefinition/obligation">
        <extension url="code">
          <valueCode value="SHALL:handle"/>
        </extension>
        <extension url="actor">
          <valueCanonical
                          value="http://hl7.eu/fhir/ig/idea4rc/actor-headneck-i4rc"/>
        </extension>
      </extension>
      <path value="Surgery.surgicalComplications"/>
      <short
             value="Surgical complications (Clavien-Dindo Classification) (M)"/>
      <definition
                  value="Describes presence and grade of complications after a surgical procedure, "/>
      <comment
               value="Absent - 4132135
Clavien-Dindo complication scale: Grade I - 715974
Clavien-Dindo complication scale: Grade II - 715975
Clavien-Dindo complication scale: Grade III - 715976
Clavien-Dindo complication scale: Grade IIIA - 715977
Clavien-Dindo complication scale: Grade IIIB - 715978
Clavien-Dindo complication scale: Grade IV - 715979
Clavien-Dindo complication scale: Grade IVA - 715980
Clavien-Dindo complication scale: Grade IVB - 715981
Clavien-Dindo complication scale: Grade V - 715982"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
    </element>
  </differential>
</StructureDefinition>