Pericardial effusion is the most common cardiac complication in cancer patients. Lung and breast cancers are the most common solid tumors associated with pericardial effusion. Multimodal tumor therapy improves the overall survival rate and reduces tumor complications. However, these patients need individualized treatment. This paper describes the treatment experience of pericardial effusion, from its pathophysiology, the correct classification of pericardial effusion related to malignant tumor, malignant pericardial effusion or pericardial cancer, to the methods of diagnosis and treatment. The incidence of pericardial effusion in our hospital was 12%. In 11 years of pericardial fenestration, pericardiectomy and subcutaneous catheter (tunneling) installation of pericardium or temporary pleurisy, the postoperative mortality was 1.2%, while the recurrence rate of pericardial effusion was 2.1%, and the recurrence rate of pericardial effusion was 33%. Malignant pericardial effusion is an oncologic emergency. It requires cost-effective management without increasing the incidence of patients who have deteriorated. Thoracoscopic pericardial fenestration (vats) and anterolateral small incision are ideal surgical approaches for malignant pericardial effusion.