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The ALCCaS Trial

A Randomized Controlled Trial Comparing Quality of Life Following Laparoscopic Versus Open Colectomy for Colon Cancer

McCombie, Andrew M., B.Sc., B.A.(Hons), Ph.D.1; Frizelle, Frank, M.B.C.H.B., M.Med.Sc., F.R.A.C.S.1; Bagshaw, Philip Frederick, B.Sc., L.R.C.P., M.B., B.S., F.R.C.S., F.R.A.C.S.1; Frampton, Chris M., Ph.D.2; Hewett, Peter J., M.B.B.S., F.R.A.C.S.3,4; McMurrick, Paul John, M.B.B.S. (Hons.), F.R.A.C.S.5; Rieger, Nicholas, F.R.A.C.S.3,6; Solomon, Michael J., M.B. B.C.H. (Hons), B.A.O., M.Sc., D.Med.Sc. (Syd), L.R.C.P.I., F.R.C.S.I.(Hons), F.R.A.C.S.7; Stevenson, Andrew R., F.R.A.C.S.8 On behalf of the ALCCaS Trial group

doi: 10.1097/DCR.0000000000001165
Original Contributions: Colorectal Cancer
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BACKGROUND: This study reports the quality-of-life assessment of the ALCCaS trial. The ALCCaS trial compared laparoscopic and open resection for colon cancer. It reported equivalence of survival at 5 years. Quality of life was measured as a secondary outcome.

OBJECTIVE: This study aimed to report on the quality of life data of the ALCCaS Trial.

DESIGN: This study reports a randomized controlled trial comparing laparoscopic with open colonic resection.

SETTINGS: The study was conducted in Australasia.

PATIENTS: Patients with a single adenocarcinoma of the right, left, or sigmoid colon, presenting for elective treatment, were eligible for randomization.

INTERVENTIONS: Open and laparoscopic colonic resections were performed.

MAIN OUTCOME MEASURES: Patient symptoms and quality of life were measured using the Symptoms Distress Scale, the Quality of Life Index, and the Global Quality of Life Score preoperatively, and at 2 days, 2 weeks, and 2 months postoperatively.

RESULTS: Of the 592 patients enrolled in ALCCaS, 425 completed at least 1 quality-of-life measure at 4 time points (71.8% of cohort). Those who received the laparoscopic intervention had better quality of life postoperatively in terms of the Symptoms Distress Scale (p < 0.01), Quality of Life Index (p < 0.01), and Global Quality of Life (p < 0.01). In intention-to-treat analyses, those assigned to laparoscopic surgery had a better quality of life postoperatively in terms of the Symptoms Distress Scale (p < 0.01) and Quality of Life Index (p < 0.01), whereas Global Quality of Life was not significant (p = 0.056). The subscales better for laparoscopic resection at all 3 postoperative time points were appetite, insomnia, pain, fatigue, bowel, daily living, and health (p < 0.05).

LIMITATIONS: The primary limitation was the different response rates for the 3 quality-of-life measures.

CONCLUSIONS: There was a short-term gain in quality of life maintained at 2 months postsurgery for those who received laparoscopic relative to open colonic resection. See Video Abstract at

1 Department of Surgery, University of Otago, Christchurch, New Zealand

2 Department of Medicine, University of Otago, Christchurch, New Zealand

3 Division of Surgery, The Queen Elizabeth Hospital, Woodville South, Australia

4 The University of Adelaide Discipline of Surgery, Adelaide, Australia

5 Department of Surgery, Monash University and Cabrini Hospital, Malvern, Victoria, Australia

6 The University of Adelaide Discipline of Surgery, Adelaide, Australia

7 Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Australia

8 Department of Colon and Rectal Surgery, Royal Brisbane & Women’s Hospital, Herston, Australia

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: This research was supported by the following grants from the National Health and Medical Research Council: NH&MRC ID 207815, NH and MRC ID 349381; Health Research Council of New Zealand: HRC 97/154 and HRC 04/102; and by Johnson & Johnson Medical NZ, Ethicon Endo-Surgery Inc. (Sydney, Australia), and the Canterbury Medical Research Foundation.

Financial Disclosures: None reported.

* Members of the ALCCaS Trial group who contributed patients. Please see the Acknowledgments.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, WA, June 10 to 14, 2017.

Correspondence: Andrew M. McCombie, Ph.D., Department of Surgery, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons