PMC5078960_01
Johns Hopkins University. a John Singer Sargent's The Four Doctors (1906) depicting the Founding Professors (left to right): Welch (pathologist & Dean), Osler (internist), Halstead (surgeon), and Kelly (gynecologist). b Early photograph of The Johns Hopkins Hospital. c Johns Hopkins Medical Class of 1892 with Dr(s) Kelly and Clark seated in the front row (third and second from the right, respectively). All images in the Public Domain
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Fig2
Evolution of en bloc and cytoreductive surgery. a Halsteadian principle of radical mastectomy; b Clark's radical hysterectomy for carcinoma of the cervix. c Magrath's demonstration of improved survival with surgical resection of abdominal Burkitt's lymphoma; d Original table from Griffith's seminal report on the impact of residual disease following surgery and survival in ovarian cancer; e Bristow's meta-analysis demonstrating that each additional 10 % effort at maximal cytoreduction confers a 5.5 % survival advantage in advanced ovarian cancer treated during the platinum era; f Overall survival curves from GOG 172 demonstrating 16 month improvement among women who had undergone optimal cytoreduction followed by intravenous-intraperitoneal chemotherapy
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Fig3
Having become influenced by the surgical doctrines of Halstead (Fig. 3a), Clark began considering the application of Halsteadian principles to en bloc radical hystererctomy for cervical cancer (Fig. 3b). As stated earlier, this work culminated in what remains a heavily cited paper in the field, specifically Bristow's meta-analysis performed while in Baltimore and published in 2002 (Fig. 3d). Finally, John Hopkins medical oncologist, Deborah Armstrong, served as the Study Chair and Principal Investigator for GOG protocol 172, the phase III randomized trial of intravenous chemotherapy vs intravenous-intraperitoneal chemotherapy which demonstrated a 16-month OS advantage in the combined therapy arm (Fig. 3f).
Understanding the physiologic responses to surgery has allowed surgeons to safely perform the multiple surgical procedures required at times to completely cytoreduce women with advanced ovarian cancer. a Dr. Francis D. Moore (1913-2001); b: Metabolic Care of the Surgical Patient by Moore; b Dr. Moore on the cover of Time Magazine, May 1963
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Fig4
At the 2015 Cytoreductive Surgery Workshop a tribute to Dr Francis Moore was made during the didactic component (Fig. 4a). His classic books, Metabolic Response to Surgery (1949) and Metabolic Care of the Surgical Patient (1959) (Fig. 4b), are regarded as masterpieces that according to Judah Folkman (1933-2008), the pioneer of angiogenesis and anti-angiogenesis therapy, changed the thinking of surgeons throughout the world and reduced suffering and mortality of their patients (Fig. 4c). At the 2015 Workshop, the purpose of the tribute was to recognize Moore's trailblazing work as that fundamental body of knowledge which has provided gynecologic oncologists with the knowledge base and confidence to pursue advanced surgical resections in women with ovarian cancer (Fig. 4b). 
Highlights from Cadaver dissections at the 2015 Surgery Workshop: a radical oophorectomy; b splenectomy with distal pancreatectomy; c hepatic mobilization; d Pringle maneuver. Figure 4a from Bristow RE, et al. J Am Coll Surg 2003; b-d from Surgery for Ovarian Cancer, 3rd Edition, Bristow RE, Karlan BY, Chi DS (eds), Taylor & Francis Group, 2015. All images used with permission
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Fig5
In addition to the stations listed above, the 2015 Workshop included cadaver dissections to demonstrate suprarenal aortic lymphadenectomy, resection of porta hepatis disease, and the Pringle maneuver in which the index finger is inserted through the foramen of Winslow and the thumb through a defect in the gastrohepatic ligament to access the porta hepatis, allowing for total inflow occlusion via an atraumatic clamp or silastic vessel loop to prevent unnecessary blood loss during wedge and/or hepatic resections (Fig. 5d).