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

Andrew M. McCombie, Frank Frizelle, Philip Frederick Bagshaw, Chris M. Frampton, Peter J. Hewett, Paul John McMurrick, Nicholas Rieger, Michael J. Solomon, Andrew R. Stevenson, on behalf of the ALCCaS Trial group

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Abstract

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 http://links.lww.com/DCR/A691.

Original languageEnglish
Pages (from-to)1156-1162
Number of pages7
JournalDiseases of the Colon and Rectum
Volume61
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018

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