Annals of surgery
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Randomized controlled trial (RCT) testing surgical intervention faced challenges due to complexities of surgery and made it more difficult for surgeons and methodologists than pharmaceutical providers to build a well-design, conduct RCT. ⋯ There is much room for improvement concerning the reported designs, conduct, and analysis of surgical RCTs. Considering the difficulty of surgical RCTs, some other approaches, such as surgeons' eligibility, performance of pilot studies, or implementation of pragmatic RCTs/expertise-based trials, should be feasibly implemented to overcome the presented challenges.