Abstract Purpose: Purpose is to compare wide pore with small pore chest drain in management of patients with malignant pleural effusion. Methods: This prospective study included 50 patients with malignant pleural effusion attended to cardiothoracic surgery department at Benha University Hospital from January 2017 to January 2019. Patients were divided into two groups; group A which included 25 patients who underwent insertion of wide pore chest drain and group B which included 25 patients who underwent insertion of small pore chest drain. Both groups were compared in terms of efficacy, safety and complications. Results: The study included 24 males and 26 females. The mean age of patients at intervention was 53 ± 12 in group A and 53 ± 13 year in group B. Initial drainage in group A was 1012 ± 369 cm3 compared with 960 ± 355 cm3 in group B (P = 0.614). Average drainage was 496 ± 188 cm3 in group A and 354 ± 167cm3 in group B (P = 0.007). The rate of complications in the form loculations and wound infection was higher in group A relative to group B with significant statistical difference (P = 0.024 and 0.023, respectively). Conclusion: Small pore chest drain was found to be more effective with fewer complications relative to large pore one in management of malignant pleural effusion.