title: What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis.
abstract: OBJECTIVE
  Among the different surgical treatments for keratocystic odontogenic tumors (KOTs), there is no single method associated with a zero recurrence rate (RR). Thus, this study aimed to seek the best surgical treatment with the least RR using a weighted event rated meta-analysis.
  
  
  METHODS
  To address our study purpose, a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was performed. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without language restrictions from inception to August 2016. Relevant articles were selected based on the following inclusion criteria: prospective, retrospective, and case series studies that assessed various treatments in non-syndromic KOTs in which RRs were included. The predictor variable was treatment groups, namely: enucleation alone, enucleation with peripheral ostectomy, enucleation with Carnoy's solution application, enucleation with cryotherapy, marsupialization alone, decompression followed by residual cystectomy, and resection. The outcome variable was RR. A weighted RR using a random effect model (because of variation in follow-up time) with a 95% confidence interval (CI) was performed. Data analysis was performed using a comprehensive meta-analysis software.
  
  
  RESULTS
  A total of 2287 KOTs in 35 studies were included in this analysis. The weighted RR for various treatment techniques was as follows: enucleation alone (23.1%), enucleation with curettage (17.4%), enucleation and Carnoy's solution (11.5%), enucleation plus liquid nitrogen cryotherapy (14.5%), marsupialization alone (32.3%), decompression followed by residual cystectomy (14.6%), and resection (8.4%). The pooled weighted overall RR of KOTs for all different treatments was 16.6%.
  
  
  CONCLUSIONS
  Radical resection remains the certain option for obtaining the lowest recurrence with KOTs. However, low recurrence accompanies enucleation with application of Carnoy's solution or cryotherapy as the first-line treatment for primary KOTs. Marsupialization (where indicated) must be followed by secondary cystectomy to minimize recurrence. We believe that to achieve the least possible morbidity, resections should be reserved for multiple recurrent lesions and possibly syndromic cases.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen. Electronic address: dressamalmoraissi@gmail.com.
authors.forename: Essam Ahmed
authors.initials: EA
authors.lastname: Al-Moraissi
authors.affiliation: Ministry of Public Health, Taiz, Yemen.
authors.forename: Ayed Ali
authors.initials: AA
authors.lastname: Dahan
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
authors.forename: Mohamed Salah
authors.initials: MS
authors.lastname: Alwadeai
authors.affiliation: Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: Fadekemi Olufunmilayo
authors.initials: FO
authors.lastname: Oginni
authors.affiliation: Department of Head Plastic and Esthetic and Reconstructive Surgery, Medicine Welcare Hospital, Dubai, United Arab Emirates.
authors.forename: Jamil Mohammed
authors.initials: JM
authors.lastname: Al-Jamali
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
authors.forename: Ahmed Saleh
authors.initials: AS
authors.lastname: Alkhutari
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
authors.forename: Nashwan Hamid
authors.initials: NH
authors.lastname: Al-Tairi
authors.affiliation: Department of Oral Medicine, Faculty of Dentistry, Thamar University, Thamar, Yemen.
authors.forename: Abdulrazaq Ahmed
authors.initials: AA
authors.lastname: Almaweri
authors.affiliation: Department of Oral Medicine, Faculty of Dentistry, Thamar University, Thamar, Yemen.
authors.forename: Jaber Saleh
authors.initials: JS
authors.lastname: Al-Sanabani
mesh_terms: D006801:Humans; D008336:Mandibular Diseases / Q000601:surgery*; D008439:Maxillary Diseases / Q000601:surgery*; D009807:Odontogenic Cysts / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
keywords: Carnoy's solution; Cryotherapy; Keratocystic odontogenic tumor; Meta-analysis; Recurrence rate; Resection