Françoise Le Pimpec-Barthes

Université René Descartes - Paris 5, Lutetia Parisorum, Île-de-France, France

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Publications (145)266.88 Total impact

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    ABSTRACT: Non-small cell lung carcinoma (NSCLC) with N1 involvement is associated with 5-year survival rates ranging from 7% to 55%. Numerous factors have been independently reported to explain this heterogeneous prognosis, but their relative weight on long-term survival is unknown.
    European Journal of Surgical Oncology 05/2015; 41(5). DOI:10.1016/j.ejso.2014.10.003 · 2.89 Impact Factor
  • European Respiratory Journal 04/2015; 45(6). DOI:10.1183/09031936.00220614 · 7.13 Impact Factor
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    ABSTRACT: Background Tobacco-induced pulmonary vascular disease is partly driven by endothelial dysfunction. The bioavailability of the potent vasodilator nitric oxide (NO) depends on competition between NO synthase-3 (NOS3) and arginases for their common substrate (L-arginine). We tested the hypothesis whereby tobacco smoking impairs pulmonary endothelial function via upregulation of the arginase pathway. Methods Endothelium-dependent vasodilation in response to acetylcholine (Ach) was compared ex vivo for pulmonary vascular rings from 29 smokers and 10 never-smokers. The results were expressed as a percentage of the contraction with phenylephrine. We tested the effects of L-arginine supplementation, arginase inhibition (by N(omega)-hydroxy-nor-l-arginine, NorNOHA) and NOS3 induction (by genistein) on vasodilation. Protein levels of NOS3 and arginases I and II in the pulmonary arteries were quantified by Western blotting. Results Overall, vasodilation was impaired in smokers (relative to controls; p < 0.01). Eleven of the 29 smokers (the ED+ subgroup) displayed endothelial dysfunction (defined as the absence of a relaxant response to Ach), whereas 18 (the ED− subgroup) had normal vasodilation. The mean responses to 10−4 M Ach were −23 ± 10% and 31 ± 4% in the ED+ and ED− subgroups, respectively (p < 0.01). Supplementation with L- arginine improved endothelial function in the ED+ subgroup (−4 ± 10% vs. -32 ± 10% in the presence and absence of L- arginine, respectively; p = 0.006), as did arginase inhibition (18 ± 9% vs. -1 ± 9%, respectively; p = 0.0002). Arginase I protein was overexpressed in ED+ samples, whereas ED+ and ED− samples did not differ significantly in terms of NOS3 expression. Treatment with genistein did not significantly improve endothelial function in ED+ samples. Conclusion Overexpression and elevated activity of arginase I are involved in tobacco-induced pulmonary endothelial dysfunction.
    Respiratory Research 03/2015; 16(1). DOI:10.1186/s12931-015-0196-4 · 3.13 Impact Factor
  • C Rivera, S Rivera, E Fabre, C Pricopi, F Le Pimpec-Barthes, M Riquet
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    ABSTRACT: In France, in 2010, tobacco induced 81% of deaths by lung cancer corresponding to about 28,000 deaths. Continued smoking after diagnosis has a significant impact on treatment. In patients with lung cancer, the benefits of smoking cessation are present at any stage of disease. For early stages, smoking cessation decreases postoperative morbidity, reduces the risk of second cancer and improves survival. Previous to surgery, smoking cessation of at least six to eight weeks or as soon as possible is recommended in order to reduce the risk of infectious complications. Tobacco could alter the metabolism of certain chemotherapies and targeted therapies, such as tyrosine kinase inhibitors of the EGF receptor, through an interaction with P450 cytochrome. Toxicity of radiations could be lower in patients with lung cancer who did not quit smoking before treatment. For patients treated by radio-chemotherapy, overall survival seems to be better in former smokers but no difference is observed in terms of recurrence-free survival. For advanced stages, smoking cessation enhances patients' quality of life. Smoking cessation should be considered as full part of lung cancer treatment whatever the stage of disease. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Revue de Pneumologie Clinique 02/2015; DOI:10.1016/j.pneumo.2014.11.009 · 0.19 Impact Factor
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    ABSTRACT: Obesity and lung cancer are major public health problems. The purpose of this work is to review the data concerning this association. We report clinical and epidemiological data on obesity and discuss the impact on the incidence of lung cancer, as well as the safety and efficiency of anti-tumor treatments. Obesity does not contribute to the occurrence of lung cancer, unlike other malignancies. Patients may be more likely to undergo treatment at lower risk. Regarding surgery, obesity makes anaesthesia more difficult, increases the operative duration but does not increase postoperative morbidity and mortality. Chemotherapy and radiotherapy seem to be administered according to the same criteria as patients with normal weight. Paradoxically, survival rates of lung cancer are better in obese patients as well after surgery than after non-surgical treatment. Obesity is related to many neoplasms but not to lung cancer. Regarding long-term survival all treatments combined, it has a favorable effect: this is the "obesity paradox". Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Revue de Pneumologie Clinique 02/2015; DOI:10.1016/j.pneumo.2014.11.006 · 0.19 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the clinical characteristics and factors that influence the long-term outcomes of solitary fibrous tumors of the pleura. We conducted a retrospective study in 2 centers and reviewed 80 patients who underwent surgery between May 1984 and April 2011. Of the 80 patients (29 male; median age, 60 years [33 to 85 years]), 47 were symptomatic (59%). The tumors originated from the visceral pleura in 62 cases (79%) and from the parietal pleura in 18 cases (22%). The tumors were pedunculated in 66 cases (83%) and sessile in 20 cases (17%). Surgical resection with histologically free margins was accomplished in 76 of 79 patients (93%). The tumors were classified as benign in 51 cases (65%) and as malignant in 28 (35%). The factors that were significantly associated with malignant tumors were the presence of symptoms (p = 0.03), a mean diameter 10 cm or greater (p = 0.0004), fibrous adherences (p = 0.003), pleural effusion (p = 0.003), and a Ki67 10% or greater (p = 0.003). The median follow-up was 69 months (range, 1 to 315). Local recurrence occurred in 3 cases. The overall 5- and 10-year survival rates were 90% and 86%, respectively, and the mean survival time was 255 ± 15 months. There were no differences between the benign and malignant tumors. The recurrence rates are low after surgeries for both benign and malignant solitary fibrous tumors of the pleura. However, the factors that are predictive of recurrence have yet to be specified and require additional immunohistochemical and genetic investigations. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of Thoracic Surgery 01/2015; 99(3). DOI:10.1016/j.athoracsur.2014.10.035 · 3.63 Impact Factor
  • A. Buero, C. Rivera, L. Gibault, F. Le Pimpec-Barthes
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    ABSTRACT: Background Osseous metaplasia is an extremely rare histological variation of thymus tumors. Despite intratumoral calcifications are described ossification is exceptional. Case report A 27-year-old woman with no relevant medical history was referred to our department for the treatment of a full-calcified anterior mediastinal tumor. It was detected on a spinal X-ray performed for chronic back pain and confirmed by a chest X-ray. On the computed tomography, a bulky anterior mediastinal tumor containing heterogeneous calcification was confirmed. The patient underwent a posterolateral thoracotomy. Intraoperatively there was a large hard stony mass in the anterior mediastinum extending to the right hemi thorax. Complete excision of the mass including thymectomy was done. The patient underwent uneventful recovery. Histopathology reported a thymoma type B1 with osseous metaplasia according to the World Health Organization classification and Masaoka I stage according to intraoperative findings. Results To our knowledge it is the third case published in all literature of a thymus tumor with complete osseous metaplasia in an adult and the first case that tumor is almost entirely ossified. Conclusion The mechanism of osseous metaplasia is unknown. Several theories have been given. Certain cell mediators would stimulate and influence connective tissue to be replaced by heterotopic bone. Further cases of osseous metaplasia will be necessary to figure out pathogenesis, prognosis and treatments outcomes of these particular types of thymomas.
    European Surgery 01/2015; DOI:10.1007/s10353-015-0310-3 · 0.26 Impact Factor
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    ABSTRACT: Le traitement chirurgical des aspergillomes pulmonaires permet de contrôler les symptômes, de prévenir les complications et d’améliorer la survie. Dans les formes accessibles à la chirurgie, l’impact d’un traitement antifongique demeure controversé. L’objectif de cette étude est d’analyser l’impact d’un traitement antifongique sur la morbidité postopératoire et la survie globale des patients opérés pour un aspergillome pulmonaire.
    Revue de Pneumologie Clinique 11/2014; DOI:10.1016/j.pneumo.2014.08.002 · 0.19 Impact Factor
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    ABSTRACT: Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma. The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2. Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P=0.30). Univariable analysis showed that immunocompromised status (P<0.001), past history of cancer (P=0.50), preoperative purulent sputum (P=0.024), and pneumonectomy (P<0.001) were significantly associated with postoperative complications, but that antifungal therapy was not. Five- and 10-year overall survival rates were respectively 78.3% and 57.8% in group 1 vs. 85.9% and 65.7% in group 2 (P=0.23). Multivariate analysis revealed that age higher than 50, immunocompromised status and pneumonectomy were significantly associated with adverse long-term survival (χ(2)=6.59, df=5, P<0.001), but that antifungal therapy was not. Antifungal therapy has no significant impact on postoperative morbidity or long-term survival following surgical resection of pulmonary aspergilloma. Such procedure is associated with acceptable postoperative morbidity and long-term survival. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Revue de Pneumologie Clinique 11/2014; · 0.19 Impact Factor
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    P. Mordant, P.-B. Pagès, B. Grand, F. Le Pimpec-Barthes, M. Riquet
    11/2014; DOI:10.1016/S1288-3336(14)68893-2
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    ABSTRACT: The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR). After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment. Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P = .033) were protective factors. Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Thoracic and Cardiovascular Surgery 09/2014; 149(1). DOI:10.1016/j.jtcvs.2014.09.063 · 3.99 Impact Factor
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    ABSTRACT: Introduction The frequency of multi and extensively drug resistant pulmonary tuberculosis (MDR/XDR-TB) is increasing worldwide, with major issues related to treatment modalities and outcome. In this setting, the exact benefits associated with surgical resection are still unknown. Methods We performed a literature review to determine the indications, morbidity, mortality and bacteriological success associated with the surgical management of MDR/XDR-TB patients. Results Altogether, 177 publications dealing with surgical resection and MDR/XDR-TB have been analyzed, including 35 surgical series and 24 cohort studies summarized in one meta-analysis. The surgical series reported success rates from 47% to 100%, complication rates from 0 to 29%, and mortality rates from 0 to 8%. The published meta-analysis reported a statistically significant association between surgical resection and treatment success (OR 2.24, IC95% 1.68–2.97). However, all these studies were associated with selection bias. International consensual guidelines included a multidisciplinary assessment in a reference centre, a personalized and prolonged antibiotic treatment and a medico-surgical discussion on a case-to-case basis. Perspectives These guidelines are now applied for the management of patients with MDR/XDR-TB in our centre. Further studies are required to avoid further increase in the burden of MDR/XDR-TB and to establish the optimal timing of medical and surgical treatments.
    Revue des Maladies Respiratoires 06/2014; DOI:10.1016/j.rmr.2014.01.014 · 0.49 Impact Factor
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    ABSTRACT: The frequency of multi and extensively drug resistant pulmonary tuberculosis (MDR/XDR-TB) is increasing worldwide, with major issues related to treatment modalities and outcome. In this setting, the exact benefits associated with surgical resection are still unknown.
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    ABSTRACT: Nowadays, early-stage lung cancers are more frequently encountered. Selective lymph node (LN) dissection based on lobe-specific lymphatic pathway has been proposed. Our aim was to study nodal involvement according to tumour location.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2014; 47(3). DOI:10.1093/ejcts/ezu226 · 2.81 Impact Factor
  • Annals of Physical and Rehabilitation Medicine 05/2014; 57:e237. DOI:10.1016/j.rehab.2014.03.871
  • Annals of Physical and Rehabilitation Medicine 05/2014; 57:e225. DOI:10.1016/j.rehab.2014.03.822
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    ABSTRACT: Geriatric oncology is a rapidly expanding domain because of the deep epidemiological changes of the last decades related to the ageing of the population. Lung cancer treatment in patients 75 years and over is a major issue of thoracic oncology. Curative surgery remains the treatment offering the best survival rates to the patient whatever his age. The important variability observed within the elderly forces us to take into account their specificities, in particular for ageing physiology and associated comorbidities. Thus, preoperative workup permitting to assess the resectability of the tumor but also the operability of the patient is all the more essential in the advanced age that it must be adapted to the particular characteristics of the elderly. Thanks to recent data of the literature, morbidity and mortality associated to surgical treatment are now better characterized and considered as acceptable in accordance with long-term survival. Clinical investigation remains essential to acquire a better knowledge of potential benefit of multimodal treatments in the elderly, for which very few data are available.
    Revue de Pneumologie Clinique 02/2014; · 0.19 Impact Factor
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    ABSTRACT: The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral or bilateral diseases. Elevation of the hemidiaphragm from peripheral origins, the most frequent situation, requires a surgical treatment only in case of major functional impact. Complete morphological and functional analyses of the neuromuscular chain and respiratory tests allow the best selection of patients to be operated. The surgical procedure may be proposed only when the diaphragm dysfunction is permanent and irreversible. Diaphragm plication for eventration through a short lateral thoracotomy, or sometimes by videothoracoscopy, is the only procedure for retensioning the hemidiaphragm. This leads to a decompression of intrathoracic organs and a repositioning of abdominal organs without effect on the hemidiaphragm active contraction. Morbidity and mortality rates after diaphragm plication are very low, more due to the patient's general condition than to surgery itself. Functional improvements after retensioning for most patients with excellent long-term results validate this procedure for symptomatic patients. In case of bilateral diseases, very few bilateral diaphragm plications have been reported. Some patients with diaphragm paralyses from central origins become permanently dependent on mechanical ventilation whereas their lungs, muscles and nerves are intact. In patients selected by rigorous neuromuscular tests, a phrenic pacing may be proposed to wean them from respirator. Two main indications have been validated: high-level tetraplegia above C3 and congenital alveolar hypoventilation from central origin. After progressive reconditioning of the diaphragm muscles following phrenic pacing at thoracic level, more than 90% of patients can be weaned from respirator within a few weeks. This weaning improves the quality of life with more physiological breathing, restored olfaction, better sleep and better speech. The positive impact of diaphragm stimulation has also been evaluated in other degenerative neurological diseases, particularly the amyotrophic lateral sclerosis. For either central or peripheral diaphragm dysfunctions, a successful surgical treatment lies on a strict preoperative selection of patients.
    Revue de Pneumologie Clinique 02/2014; · 0.19 Impact Factor
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    ABSTRACT: The management of localized non-small cell lung cancer (NSCLC) has been modified over the last decades, with induction therapies being increasingly recommended as a prerequisite to surgical resection. However, the relative impact of chemo- and chemoradiotherapy on tumours' pathology and patients' survival is still discussed. We set a retrospective study including every patient who underwent surgical resection for NSCLC in 2 French centres from 1980 to 2009. We then compared the tumours' pathology and patients' survival according to the use of induction chemotherapy (group 1) or induction chemoradiotherapy (group 2). There were 733 patients in group 1 and 126 patients in group 2. In group 1, 669 patients (91%) had platinum-based chemotherapy, for 2 to 3 cycles in 564 cases (77%). In group 2, chemoradiotheray was concomitant in 68 patients (54%), and sequential in 58 patients (46%). As compared with group 1, group 2 was characterized by younger age (mean 59.8±9.5 vs 56.4±9.6, respectively, P<.001), a higher rate of tumours deemed unresectable before induction treatment (25% vs 44%, P<.001), and a higher proportion of T4 (25% vs 44%, P<.001) or N2 diseases (56% vs 69%, P=.005). The type of resection, postoperative complications, and postoperative mortality were not significantly different between groups. On final pathologic report, as compared with group 1, there were more N0 and N1 disease in group 2 (N0: 43% vs 58%, P=.002; N1: 22% vs 10%, P=.002) while the rate of N2 disease was comparable (34% vs 32%, P=ns). The median, 5-, and 10-year survivals were 28 months, 35%, and 21% for group 1, and 29 months, 36%, and 23% for group 2, respectively (P=ns). As compared with induction chemotherapy, induction chemoradiotherapy was performed in more advanced NSCLC, and resulted in better downstaging, similar postoperative course, and comparable long-term outcome after surgical resection.
    Revue de Pneumologie Clinique 02/2014; DOI:10.1016/j.pneumo.2013.12.008 · 0.19 Impact Factor
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    ABSTRACT: Surgical resection is a validated therapeutic option for selected cases of pulmonary tumors invading the important mediastinal structures (caval vein, atrium, aorta or supra-aortic trunks). Here, we present a patient with a necrosed pulmonary tumor invading the left atrium, causing cardiac insufficiency. A complete surgical resection under extracorporeal circulation was performed by the thoracic and cardiac teams. Admitted in a bed-ridden state, the patient was discharged completely rehabilitated on postoperative day 13. He survived 1 year at home with a good quality of life.
    Revue de Pneumologie Clinique 02/2014; · 0.19 Impact Factor

Publication Stats

757 Citations
266.88 Total Impact Points

Institutions

  • 2009–2015
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Victor Dupouy
      Argenteuil, Île-de-France, France
  • 2008–2015
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service d’Anatomie-Pathologie
      Lutetia Parisorum, Île-de-France, France
  • 2014
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2006
    • Université Paris 13 Nord
      Île-de-France, France
  • 2005
    • Assistance Publique Hôpitaux de Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France