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Keloid Excision and Adjuvant Treatments

A Network Meta-analysis

Siotos, Charalampos MD*; Uzosike, Akachimere C. BA*; Hong, Hwanhee PhD; Seal, Stella M. MLS; Rosson, Gedge D. MD*; Cooney, Carisa M. MPH*; Cooney, Damon S. MD, PhD*

doi: 10.1097/SAP.0000000000001951
Burn Surgery and Research

Background Keloid disease treatment continues to be unsatisfactory with high recurrence rates. We evaluated the literature regarding the effectiveness of keloid excision with various adjuvant treatments following surgery and assessed recurrence rates.

Methods We systematically searched databases through November 2016. We performed pairwise meta-analyses and Bayesian network meta-analyses on the number of recurrences.

Results Following screening, 14 studies including 996 patients with various types of keloids were eligible for inclusion. Patients were categorized based on the receipt of surgery and the type of adjuvant treatment employed afterward. Paired meta-analysis (6 meta-analyses) showed that “excision + 1 adjuvant drug” led to statistically significantly higher odds of recurrence compared to “excision + radiation” (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.35–7.67). Based on the network meta-analyses, the ORs of keloid recurrence following various treatments compared to no excision were as follows: “excision + pressure, 0.18 (95% CI, 0.01–7.07); excision + 2 adjuvants drugs, 0.47 (95% CI, 0.02–12.82); excision + radiation, 0.39 (95% CI, 0.04–3.31); excision + skin grafting, 0.58 (95% CI, 0.00–76.10); excision + 1 adjuvant drug, 1.76 (95% CI, 0.17–21.35); and excision only, 2.17 (95% CI, 0.23–23.95).

Conclusions According to our results, “excision + radiation” had significantly better outcomes than excision alone. “Excision + pressure” had better outcomes than excision + any other treatment modality, and excision + nonradiation adjuvant therapies were also better than “excision only,” although these findings did not reach statistical significance.

From the *Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine; and

Bloomberg School of Public Health and

Welch Medical Library, Johns Hopkins University, Baltimore, MD.

Received November 2, 2018, and accepted for publication, after revision March 4, 2019.

Conflicts of interest and sources of funding: none declared.

Reprints: Damon S. Cooney, MD, PhD, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21205. E-mail:

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Online date: June 20, 2019

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