Heres my take.

# make array print properly
$"="\t"
# assuming this while loop goes through file
while (<INFILE>) {
  # these should remove line changes
  chomp;
  s/\r$//o;
  
  # split and clean $line[0]
  my @line=split (/\t/,$_);
  $line[0]=~s/^"|"$//go;

  # get the aliases from line[4]
  # $1 should be aliases and word 'alias:' is removed
  $line[4]=~s/(?:alias:)? ([\d\s,]+)"$/$1/o;
  # place things back and add $line[0]
  $line[4].="alias: $1, $line[0]\"";

  # get the new alias and place it $new_alias
  my $new_alias;
  $line[0]="\"$new_alias\"";
  # assuming we want newline use this, change "\n" if want different
  print OUTFILE "@line\n"
}
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This is untested so i cannot be sure it works.

UPDATE:
Forgot the "" in $line4, fixed that