Kocher maneuver to facilitate cytoreduction within the foramen of Winslow.

A potential site for incomplete cytoreduction in patients with peritoneal metastases is the foramen of Winslow, especially the posterior aspect of the hepatoduodenal ligament. The Kocher maneuver can be used to rotate the duodenum, head of pancreas, and portal structures 180°. In so doing, the foramen of Winslow is clearly exposed for peritonectomy. Residual tumor at this site is a prominent cause of unnecessary treatment failure in the management of patients with mucinous appendiceal neoplasms.