Keloid Excision and Adjuvant Treatments: A Network Meta-analysis

Charalampos Siotos, Akachimere C. Uzosike, Hwanhee Hong, Stella M. Seal, Gedge David Rosson, Carisa Miller Cooney, Damon Cooney

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)154-162
Number of pages9
JournalAnnals of plastic surgery
Volume83
Issue number2
DOIs
StatePublished - Aug 1 2019

Fingerprint

Keloid
Confidence Intervals
Recurrence
Radiation
Therapeutics
Meta-Analysis
Pharmaceutical Preparations
Pressure
Skin Transplantation
Network Meta-Analysis
Odds Ratio
Databases

Keywords

  • keloid
  • meta-analysis
  • reconstruction
  • review
  • scar

ASJC Scopus subject areas

  • Surgery

Cite this

Keloid Excision and Adjuvant Treatments : A Network Meta-analysis. / Siotos, Charalampos; Uzosike, Akachimere C.; Hong, Hwanhee; Seal, Stella M.; Rosson, Gedge David; Cooney, Carisa Miller; Cooney, Damon.

In: Annals of plastic surgery, Vol. 83, No. 2, 01.08.2019, p. 154-162.

Research output: Contribution to journalArticle

Siotos, Charalampos ; Uzosike, Akachimere C. ; Hong, Hwanhee ; Seal, Stella M. ; Rosson, Gedge David ; Cooney, Carisa Miller ; Cooney, Damon. / Keloid Excision and Adjuvant Treatments : A Network Meta-analysis. In: Annals of plastic surgery. 2019 ; Vol. 83, No. 2. pp. 154-162.
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abstract = "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.",
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AU - Rosson, Gedge David

AU - Cooney, Carisa Miller

AU - Cooney, Damon

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N2 - 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.

AB - 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.

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