Pericardiocentesis Versus Surgical Pericardial Window for First Occurrence of Malignancy-Related Pericardial Effusion: A meta-analysis of retrospective studies

Background Malignancy-Related pericardial effusion (MRPE) is a serious complication of advanced cancer, potentially leading to life-threatening cardiac tamponade. While both pericardiocentesis and surgical pericardial window are used for management, data on comparative efficacy and safety remain heterogeneous. Aims To compare the efficacy and safety of pericardiocentesis versus surgical pericardial window in the management of the first occurrence of MRPE. Methods We systematically searched PubMed, Cochrane, and Google Scholar up until May 2025. Articles directly comparing pericardiocentesis to surgical pericardial window, which include patients with MRPE, have first occurrence procedure outcome data, and published in English were included. Our outcomes consisted of procedure failure (composite of inability to drain, inability to relieve symptoms or recurrence of effusion), bleeding, infection, pneumothorax, supraventricular tachyarrhythmias (SVT), and death. Results A total of six articles met our inclusion criteria, representing a total of 1,369 patients, 1086 of whom underwent pericardiocentesis and 253 surgical pericardial windows. Procedure failure was significantly higher in the pericardiocentesis group when compared to the surgical approach (Odds Ratio (OR): 2.99, 95% CI 1.10-8.14, p=0.03), while more deaths were reported in the surgical pericardial window group (OR: 0.68, 95%CI 0.46-0.99, p=0.05). There was no difference between the two groups for bleeding (p=0.051), infection (p=0.11), pneumothorax (p=0.56), or SVT (p=0.31). Conclusion Both pericardiocentesis and surgical pericardial window showed comparable rates of infection, bleeding, SVT, and pneumothorax in patients with MRPE. However, due to the nature of the procedures, a lower failure rate was seen in surgical pericardial window with a higher death rate.