Efficacy and safety of surgical excision combined with postoperative radiotherapy for keloids: A systematic review and meta-analysis with implications for nursing care

Keloids, characterized by excessive fibrous tissue proliferation, pose a clinical challenge due to high recurrence rates and impact on quality of life. Surgical excision alone yields recurrence rates >50%, prompting integration of postoperative radiotherapy (RT) as adjuvant therapy. Nursing care is critical for managing RT-related toxicities and optimizing outcomes, yet its integration into systematic reviews and meta-analyses remains limited, with a notable gap in evidence synthesis focusing on nursing-sensitive outcomes. To systematically review the efficacy and safety of surgery combined with postoperative RT for keloids and to synthesize the available evidence on nursing interventions for post-treatment care. A PICOS framework-guided search was conducted in CNKI, PubMed, Web of Science, EMBASE, and Cochrane Library (inception to March 2025). Studies comparing surgery + RT vs. RT alone or triamcinolone acetonide (TA) were included. Risk of bias was assessed using Cochrane RoB 2.0 (RCTs) and ROBINS-I (cohort studies). Pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated via meta-analysis. Nursing interventions were consistently associated with reduced RT-induced skin toxicities, improved patient compliance, and enhanced multidisciplinary coordination in 6 of the 9 included studies. Nine studies (3 RCTs, 6 cohorts; 1094 patients) were included. Surgery + RT vs. RT alone: Higher cure rate (OR = 1.92, 95% CI: 1.42–2.58, p < 0.0001) and effective rate (OR = 2.79, 95% CI: 1.89–4.14, p < 0.00001), with comparable adverse event rates (OR = 0.59, 95% CI: 0.26–1.30, p = 0.19). Surgery + RT vs. TA: Higher cure rate (OR = 4.52, 95% CI: 2.99–6.83, p < 0.00001) and effective rate (OR = 6.47, 95% CI: 3.70–11.31, p < 0.00001), with fewer adverse events (RR = 0.30, 95% CI: 0.11–0.84, p = 0.02). Nursing interventions mitigated RT-induced skin toxicities (e.g., erythema, desquamation), improved patient compliance, and facilitated multidisciplinary care. Surgery combined with postoperative RT is effective and safe for keloids, outperforming monotherapies. Nursing care is integral to managing toxicities, enhancing compliance, and optimizing long-term outcomes, warranting integration into standardized keloid management pathways. The synthesis of nursing-related outcomes supports the structured integration of nursing care into keloid management protocols.