Background <p>Colorectal cancer (CRC) remains a global malignancy with high morbidity and mortality. Long-term uncontrolled intestinal inflammation drives CRC initiation and development. As a vital essential fatty acid and prostaglandin precursor, arachidonic acid (AA) participates in inflammatory and immune regulation, and its metabolic disorder is tightly linked to multiple inflammatory diseases and CRC. This study clarified the progress of research on AA metabolism and CRC through bibliometric analysis, and analyzed the clinical application prospects of COX inhibitors in CRC by integrating clinical trial data.</p> Methods <p>For bibliometric analysis, data were retrieved from WOSCC (1990–2025) using specific search terms, preprocessed, and analyzed via R Studio and LDA topic model to clarify publication trends and research hotspots. Meanwhile, relevant clinical trials of COX inhibitors for CRC and its precancerous lesions were collected from the Trialtrove database for multidimensional analysis.</p> Results <p>This bibliometric analysis highlights the significant growth in research on AA metabolism in colorectal cancer, identifying key authors, countries, and research hotspots. The field has transitioned from a focus on COX-2 and PGE2 to a more integrated understanding that includes gut microbiota and immune modulation. For clinical trial analysis, among the 61 included trials, aspirin and celecoxib monotherapies were dominant, and combination regimens have drawn rising attention. Regarding trial status, less than one-third of trials were completed, while plenty remained active or terminated early.</p> Conclusion <p>By synthesizing the results of bibliometric and clinical trial landscape studies, we summarized drugs targeting the AA pathway that inhibit inflammatory cancer transformation.</p>