Randomized trials are the cornerstone of evidence based surgery. These trials are performed best in a multicenter collaboration. In this presentation I will give examples of two successful nationwide study groups, the Dutch Pancreatitis Study Group and the Dutch Pancreatic Cancer Study Group as well as a successful international study group the European consortium on Minimally Invasive Pancreatic Surgery. I will show how the use and quality of RCTs differs worldwide based on a Pubmed review and demonstrate two new RCT designs which may facilitate surgical RCTs.