Objectives: Malignant pericardial effusion is characterized by the infiltration of cancer cells into the pericardium. It can worsen the prognosis due to its association with advanced-stage cancer and metastatic spread to the pericardium. The prognosis is further influenced by the type and stage of the underlying cancer, the response to cancer treatment, and the extent of pericardial involvement. Our aim was to examine whether the effusion’s method of therapy has an impact on the prognosis. Methods: From 2019 to 2022, 34 patients hospitalized for neoplastic pericarditis were included in this retrospective study. They all had an anti-neoplastic treatment. We analysed the outcomes of patients who underwent pericardiocentesis versus surgical drainage, with a primary emphasis on one-year mortality rates and recurrence rates. Univariate analysis was done using the Fisher test, and a p-value <0,01 was considered significant. Results: Among all our patients, one-year mortality was 74%, and the recurrence rate was 47%. There were higher mortality and recurrence rates at 1 year in patients who had pericardiocentesis compared to those who had surgical drainage, respectively, 80% vs. 50% and 62% vs. 0%. However, only the difference in recurrence rate was considered significant (p<0,01). Conclusions: Surgical pericardial drainage, compared to pericardiocentesis, reduces the recurrence of neoplastic pericarditis. Further research is needed to more specifically compare the impact of all treatments on patient prognosis and to establish an individual treatment plan.