Global landscape and temporal trends of colorectal surgical trials

Background: Colorectal diseases include benign conditions (diverticulitis and inflammatory bowel disease) and colorectal cancer, a leading global malignancy. Minimally invasive surgery has evolved from open to laparoscopic and robotic approaches. Robotics enhances visualization and precision, especially in complex cases. This cross-analysis evaluates surgical trials across colorectal diseases. Methods: A comprehensive search of ClinicalTrials.gov identified colorectal surgical trials. Eligible studies involved adult patients undergoing laparoscopic, open, or robotic colorectal surgery for benign or malignant conditions, reporting clinical outcomes. Data extracted included trial characteristics, surgical approach, outcomes, funding, and country. Multinational trials were analyzed using raw and fractional country metrics. Country patterns were visualized with a ranked bar chart and choropleth maps. Temporal trends were assessed by annual counts and locally estimated scatterplot smoothing. Analyses were conducted using R and SPSS. Results: From 1,051 identified trials, 273 met eligibility criteria. These enrolled 199,482 patients, primarily studying colon and rectal cancer, with laparoscopy predominating. Postoperative complications and oncologic outcomes were most reported. Most trials were completed or ongoing, enrolled adults of both sexes, and had nonspecified funding. China, Italy, and the USA led trial contributions. Trial initiation increased markedly after 2010, peaking in 2023, with sustained high activity through the 2010s and early 2020s. Conclusions: Colorectal surgical trials increased recently, emphasizing laparoscopy and oncology, with geographic concentration and limited patient-centered, economic outcome reporting.