Management and outcomes of patients with symptomatic malignant pericardial effusion

Background Although solid tumors and haematological malignancies represent a significant percentage of all pericardial effusion cases, the characteristics, optimal therapeutic management strategy (percutaneous pericardiocentesis (PPC) or surgical drainage) and prognosis of these patients are poorly understood. Objectives To evaluate the features and outcomes of patients with malignant pericardial effusion (MPE) admitted for PPC or surgical drainage. Methods This single centre registry included all patients referred to our institution for symptomatic pericardial effusion between 2014 January 1 st and 2017 December 31 st . We retrospectively identified patients with suspected MPE and analyzed their clinical and procedural characteristics, overall mortality and drainage recurrence rate. Results A total of n  = 68 patients (median age: 61 (15.5) y; Male gender: 43%) were included in the analysis. Malignant diseases were mainly lung (49%), breast (18 %), digestive tract (15%) cancers, hemopathies (6%) and melanoma (2%). A total of n  = 44 patients underwent PPC (65%) whereas n  = 24 underwent surgical management (35%). There was no significant difference in baseline characteristics between the two groups. There was no major procedure-related complication in both groups. MPE severely affected outcome: the 1–year actuarial survival was 32.1 ± 6.1%. The 1-year actuarial survival from MPE recurrence was 88 ± 5%. There was no difference between surgical drainage and PPE in terms of global survival and risk of recurrence. Cox regression analysis revealed that presence of malignant cell within the pericardial fluid was the only independent predictors of death in this cohort. Conclusion MPE is mostly related to solid tumors and is associated with poor prognosis. There is no significant difference in outcome between PPC and surgical treatment, suggesting that both strategies are valuable options to manage this affection.