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

Dis Colon Rectum. 2018 Oct;61(10):1156-1162. doi: 10.1097/DCR.0000000000001165.


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

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adenocarcinoma / surgery*
  • Aged
  • Aged, 80 and over
  • Australasia / epidemiology
  • Colectomy / methods*
  • Colon, Sigmoid / pathology
  • Colon, Sigmoid / surgery*
  • Colorectal Neoplasms / psychology
  • Colorectal Neoplasms / surgery*
  • Elective Surgical Procedures / methods
  • Female
  • Humans
  • Intention to Treat Analysis / methods
  • Laparoscopy / methods*
  • Length of Stay
  • Male
  • Middle Aged
  • Postoperative Period
  • Quality of Life / psychology*
  • Treatment Outcome