The subpyloric space: an important surgical and radiologic feature in pseudomyxoma peritonei

Aims: If mucinous appendiceal tumours widely distributed throughout the peritoneal space are completely removed by peritonectomy procedures, quality of life and survival benefits result with an acceptable morbidity and mortality. In some patients mucinous tumour that surrounds the stomach is an important consideration in accomplishing a complete cytoreduction. Methods: Mucinous tumour that enters the lesser sac through the foramen of Winslow will accumulate by gravity in the subpyloric space. This is a cul-de-sac beneath the pylorus. For complete cytoreduction mucinous tumour accumulation in the subpyloric space must be cleared. Results: If there is tumour accumulation in the subpyloric space and the left gastric artery can be preserved by peritonectomy, one can achieve a complete cytoreduction without gastrectomy. In a majority of patients, resection of mucinous tumour from the subpyloric space requires total gastrectomy for complete cytoreduction. Conclusion: Knowledge of mucinous tumour distribution and anatomy of the subpyloric space will facilitate complete cytoreduction in selected patients with pseudomyxoma peritonei syndrome.