Pericardiocentesis vs. surgical pericardial window for first occurrence of malignancy-related pericardial effusion: a meta-analysis of retrospective studies

TL;DR

This study compares two treatments for a dangerous heart condition caused by cancer, finding that one has fewer failures but more deaths.

Contribution

A meta-analysis comparing pericardiocentesis and surgical pericardial window for first-time malignancy-related pericardial effusion.

Findings

Surgical pericardial window had significantly lower procedure failure compared to pericardiocentesis.

Pericardiocentesis was associated with higher failure rates but lower mortality compared to surgical pericardial window.

Both procedures had similar rates of infection, bleeding, pneumothorax, and arrhythmias.

Abstract

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. This study aims to compare the efficacy and safety of pericardiocentesis vs. surgical pericardial window in the management of the first occurrence of MRPE.

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. A total of six articles met our inclusion criteria, representing a total of 1369 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).

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.

Graphical AbstractFor image description, please refer to the figure legend and surrounding text.

Figures