symptomatic malignant pericardial effusion is found predominantly in patients with lung , breast , and hematologic malignancies , while benign pericardial effusion is usually idiopathic , caused by infection , or secondary to radiation and drugs used in the treatment of cancer . case series have reported that malignancy accounts for up to 23% of pericardial effusions and up to 33% of symptomatic pericardial effusions . clinical presentation is often subtle at first , tamponade with hemodynamic compromise may occur and result in premature death . surgical pericardial window has largely been accepted as a simple , safe , and effective procedure , and the standard method for long - term drainage of pericardial effusion . these include the subxiphoid , laparoscopic , thoracoscopic , pericardioscopic , percutaneous balloon window , open - thoracotomy , and sternotomy approaches . the choice depends on the surgeon personal experience , the general state of the patient , and the current therapeutic trend . given the limited life expectancy of patients with malignant diseases , the challenge for the clinician is to determine the long - term benefits of a surgical intervention . even though immediate and short - term palliation is obtained by creating a surgical pericardial window , long - term survival of patients with major co - morbidities and/or widespread metastatic involvement may not be improved by surgery . similar results may be achieved by non - surgical intervention , such as repeated pericardiocentesis , pericardial catheter and chemical sclerosis . the objective of this study is to review the survival of patients treated with a subxiphoid pericardial window . a secondary objective is to provide concrete data to better assist the surgeon , the patient , his or her family , and referring physician in making an informed decision regarding available treatments . in this study , we retrospectively reviewed the medical records of 60 consecutive patients based on a prospective database who underwent a surgical pericardial window for pericardial effusion . all patients were operated by either one of three surgeons in a university - affiliated hospital , between february 1994 and november 2008 . we collated the following data : age , sex , history of cancer , co - morbidities , symptoms at presentation , temporary treatment with preoperative pericardiocentesis or pericardial catheters , date of surgery , cytology studies of the aspirated pericardial fluid , histology examinations of the excised pericardium . we have chosen the subxiphoid approach because of simplicity , practicality , and local expertise . overall survival was calculated from the date of surgery ( pericardial window ) to the end of the study period or death . we have chosen the subxiphoid approach because of simplicity , practicality , and local expertise . overall survival was calculated from the date of surgery ( pericardial window ) to the end of the study period or death . the group included 33 female patients ( 55% ) and 27 male patients ( 45% ) with a mean age of 60 years ( age range : 40 to 82 years ) . fifty patients ( 83% ) presented with clinical symptoms , including isolated dyspnea ( n=23 ) , pretamponade ( n=15 ) , and cardiac tamponade ( n=25 ) defined as the presence of right atrial and ventricular collapse at echocardiography . forty - six patients ( 77% ) benefited from rapid relief of symptoms after drainage by pericardiocentesis with or without insertion of a pericardial catheter . the underlying cause of pericardial effusion was confirmed in most cases by pre- and/or intra - operative cytological study of aspirated pericardial fluid and histological examination of the excised pericardium . in 25 patients ( 42% ) , cytological studies alone were positive for malignant cells ; these results were confirmed in another seven patients ( 12% ) by histological studies of the resected pericardium . the primary malignancy was located in the lung in the majority of patients ( n=43 ) , and the origin was unknown in four patients ( table 1 ) . table 1origin of malignancy in patients with malignant pericardial effusion.site of primary tumorno.%lung4372unknown47esophagus35breast23other cancer813 
  thirteen patients ( 22% ) had surgical complications , which consisted of atrial fibrillation ( n=6 ) , pneumothorax ( n=1 ) , thrombocytopenia ( n=1 ) , supraventricular tachycardia ( n=1 ) , delirium ( n=2 ) and cardiac laceration ( n=1 ) . there was one ( 2% ) in - hospital death resulting from a postoperative complication in one of the patients who underwent a second pericardial window for recurrence . overall 30-day mortality was 31% ( n=18 ) and 30% ( n=13 ) in patients with lung cancer ( table 2 ) . overall survivals at 3 months , 6 months , 1 year and 2 years were 45% ( n=27 ) , 28% ( n=16 ) , 17% ( n=10 ) , and 9% ( n=5 ) , respectively . in patients with lung cancer , the corresponding survivals were 40% ( n=16 ) , 26% ( n=10 ) , 15% ( n=6 ) , and 8% ( n=3 ) , respectively . the overall post - operative median survival was 2.6 months , 2.1 months for patients with lung cancer , and 4.7 months for those with other malignancies . table 230-day mortality.30-day mortalityno.%overall1831  lung1330  unknown125  esophagus267  breast00  other cancer225 
 
 figure 1survival rates ( lung vs non lung cancer ) . according to literature , metastasis to the pericardium represents a contributive cause of death in 86% of patients with symptomatic pericardial effusion . advanced lung cancer is the predominant cause of metastatic involvement of the pericardium . in our patient population survival rates are consistently poor in patients with malignancy who present with a pericardial effusion . in our series , patients had a median survival of 2.6 months . patients with lung cancer had a median survival of 2.1 months while those with other types of cancer of 4.7 months . as in other studies , patients with lung cancer and pericardial effusion had the worst prognosis . in this study , only 17% of patients survived the first year after surgical intervention , which includes 15% of patients with lung cancer . other case studies report survival rates at 1 year of 25% , and for lung cancer patients of 10.5% . pericardiocentesis provides immediate palliation of symptoms and has a small rate of major complications , including ventricular puncture , cardiac tamponade , arrhythmia , and cardiac arrest . pericardiocentesis alone was not previously considered as a definite method of treatment for pericardial effusion as it had been associated with a rate of recurrence of up to 90% at 3 months . its complications have been reduced to 1.5% by echocardiography - guidance and the recurrence rate of pericardial effusion was lowered to 40% at 6 months . alternative therapies include local sclerosing of the pericardium by instillation of a chemical agent through a pericardial catheter . martinoni reports an absence of pericardial effusion at 30 days after drainage and sclerosis in 7090% of treated patients . maher favors drainage and sclerosis over surgical drainage alone pointing that this procedure offers similar survival with lower morbidity , mortality , and recurrence rates , and mentions that the surgical option should be reserved to pericardial effusion refractory to the sclerosing therapy . in conclusion , it must be clearly understood by the patient and the consulting medical service that the surgical intervention will not affect the long - term survival in these already frail patients who may not be able to tolerate the additional surgical stress . the use of the pericardial window procedure in patients with advanced malignancy should be considered on a case - by - case basis depending on the symptoms , general status of the patient , and expected survival . we finally recommend an honest and open discussion with the patient , his or her family , and the referring physician to make an informed decision regarding all available surgical and non - surgical treatments . we propose as treatment algorithm : i ) pericardiocentesis with or without an indwelling catheter , ii ) followed by chemical pericardial symphysis with a sclerosing agent , iii ) and finally a subxiphoid pericardial window for recurrence .
the study reviews the survival of patients with malignant pericardial effusion treated with a subxiphoid pericardial window 
 . the medical records of 60 consecutive patients diagnosed with a malignant pericardial effusion and treated with a subxiphoid pericardial window between 1994 and 2008 were reviewed . 
 72% had lung cancer . 
 overall 30-day mortality was 31% . 
 survival rates at 3 months , 6 months , 1 year , and 2 years were 45% , 28% , 17% , and 9% , respectively . 
 overall median survival was 2.6 months.patients with malignant pericardial effusion , especially those with primary lung cancer have poor survival rates . 
 in advanced malignancy , the subxiphoid pericardial window procedure provides only short - term palliation of symptoms , and has no effect on long - term survival . 
 the use of any surgical procedure in patients with malignant advanced pericardial effusion should be considered along with non - surgical options on a case - by - case basis depending on symptoms , general status , and expected survival .