Objective To explore the current research status, hotspots and trends in the field of immunotherapy resistance in colorectal cancer based on bibliometric analysis.

Methods Literature related to immunotherapy resistance in colorectal cancer published in Web of Science database from January 1, 2015 to August 30, 2025 was retrieved. VOSviewer 1.6.17 and CiteSpace 6.4.R1 softwares were employed to perform visual analysis of authors, countries, institutions and keywords, and keyword clustering and co-occurrence analysis were conducted.

Results A total of 1 420 articles were included. The number of publications on immunotherapy resistance in colorectal cancer from 2015 to 2025 showed an overall upward trend. Cohen Romain and Zhang Yan had the highest number of publications (8 each). China had the highest number of publications (n= 660) and the highest citation frequency (19 223 times). The institution with the highest number of publications was Sun Yat-sen University (n= 61). The main research hotspots included the mechanism of immunotherapy resistance in colorectal cancer, biomarkers for predicting the efficacy of immunotherapy in colorectal cancer and improving the efficacy of immunotherapy in colorectal cancer.

Conclusion Although significant progress has been made in the related research on the immunotherapy resistance in colorectal cancer, the transformation of existing research achievement to clinical precision medicine still faces challenges such as high heterogeneity and difficulty in optimizing combination regimens. Clinical precision medicine may become a key research direction in the future. It requires the use of multi-omics integration, dynamic monitoring and artificial intelligence modeling to promote the clinical translation of resistance warning models and the optimization of personalized treatment strategies.

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