The Joint Competence Center of Rare Gastrointestinal and Hepatopancreatobiliary Diseases was established in 2017 by a team of specialists from Vilnius University Hospital Santaros Klinikos (VUH SK) and National Cancer Institute (NCI). It aims to provide comprehensive multidisciplinary healthcare to patients with rare gastrointestinal cancers and other rare surgical gastrointestinal diseases. Competence Center unites abdominal surgeons, gastroenterologists, oncologists, chemotherapists, radiologists, geneticists and other specialists specialised in rare gastrointestinal diseases. Competence center has accumulated long-term experience in the diagnostics, treatment and multidisciplinary care and has all required equipment to diagnose and treat rare gastrointestinal diseases. Specialists in the center carry out research and teaching activities, apply modern diagnostics and treatment technologies and newest disease management guidelines.
The Joint Competence Center of Rare Gastrointestinal and Hepatopancreatobiliary Diseases cooperates in these activities:
VUH SK and NCI (in cooperation with Vilnius University Faculty of Medicine and other research institutions in Lithuania and abroad) perform various teaching activities including undergraduate and postgraduate residency and doctoral studies of all levels, internships and teaching programs for physicians and nurses and a wide variety of scientific research. Members of the Joint Competence Center are also members of many national and international professional organizations. The results of scientific activities are regularly presented in national and international conferences and scientific publications. All specialists of the Competence center are regularly improving their skills in healthcare and research institutions abroad.
This is the core multidisciplinary team of the competence center. When required, additional specialists of other specialties from VUH SK and NCI are invited to multidisciplinary team meetings and consultations.
All specialists of the core team are regularly improving their skills in international events and internships, where they learn new modern diagnostics and treatment methods and participate in international expert activities.
According to EU definition, rare tumours are tumours with frequency (incidence) of 6 or less cases per 100 000 population per year [RARECARENet, http://www.rarecarenet.eu/]. Overall incidence of rare tumours in the EU is increasing due to improvements in pathological and molecular diagnostics and fragmentation of common tumour forms into molecular types. Currently, rare tumours comprise over 20% of all tumours, diagnosed in the EU. Rare tumours comprise ~15% of all gastrointestinal tumours. Although survival of patients with rare tumours is improving (according to RARECARENet, survival rate has improved by 3% between 1997 and 2007), significant differences remain when compared to common tumours. The main factors leading to these differences are biological factions of the diseases, limited access to timely and accurate diagnosis and lack of effective, modern treatment methods, medicines and guidelines.
Competence center provides all secondary and tertiary inpatient and outpatient abdominal surgery services, emergency and scheduled healthcare, all modern abdominal surgery procedures, including liver, pancreas, simultaneous pancreas and kidney transplants. In cases of malignant tumours surgery is usually combined with preoperative or postoperative chemotherapy or radiotherapy. Each year, about 800 patients with gastrointestinal tumours are treated and about 120 new patients are diagnosed. All patients are thoroughly examined before surgery by using modern imaging (endosonoscopy, CT, MRI, gamma camera) and laboratory (cancer markers, inflammatory markers, hormones, oncogenes) tests, pelviperineology, functional gastrointestinal and coloproctological laboratories and discussed in multidisciplinary team meetings. When possible, diseases are treated by minimally invasive laparoscopic surgery. In cases of widespread, unresectable tumours of pancreas, bile ducts, rectum, duodenum or esophagus with tumour induced narrowing, the narrowing is dilated with endoscopically placed stents. Patients with locally spread tumours undergo complex multivisceral oncological surgeries, during which irreversibly damaged organs are removed (in accordance with the principles of good practice in the treatment of oncological diseases, en bloc). If required, abdominal vascular reconstruction surgery is performed. If cancer is spread in the abdomen, cytoreductive treatment and hyperthermic intraperitoneal chemotherapy (HIPEC) are performed. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is also available.
NCI is the pioneer of radiotherapy in Lithuania, has accumulated long-term experience in the fields and uses modern linear accelerators in treatment. These devices allow three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), stereotactic body radiation therapy (SBRT), image-guided radiation therapy (IGRT), radiotherapy for respiratory tumours (4D-CT, RPM), HDL and LDR brachytherapy.
In NCI Chemotherapy department and Day hospital and VUH SK Oncochemotherapy department and Day hospital, patients are treated with all chemotherapeutic medicines available in Lithuania: intravenous, subcutaneous, short-term or long-term and oral, as well as biological therapy, immunotherapy, hormone therapy, bisphosphonate treatment, blood component transfusions, management of side effects of the treatment. Patients treated with a combination of chemotherapy and radiotherapy are also treated here. Complex treatment methods are used in collaboration with other highly skilled specialists: intraarterial chemotherapy (e.g. direct medicine administration to the blood vessels of the liver), intraperitoneal chemotherapy, chemoembolization (for treatment of hepatic metastases) or hypertonic intraperitoneal chemotherapy (for the treatment of peritoneal carcinoma of the stomach, intestinal cancer, peritoneal mesothelioma and others).
The implementation of applied oncology research and clinical research, the introduction of advanced diagnostic and treatment methods into clinical practice and cooperation with other scientific institutions and international organizations are an integral part of NCI and VUH SK activities. Specialists of the competence center are actively participating in international clinical trials to provide patients with gastrointestinal tumours (especially rare tumours) access to innovative treatment or extensive markers and genetic testing.
Multidisciplinarity in NCI and VUH SK has been applied for many years. All primary patients with gastrointestinal tumours and more complex cases are discussed during multidisciplinary meetings. Multidisciplinary meetings help to ensure the most appropriate, coordinated, rational, timely, guideline-based diagnostics, treatment and monitoring of patients with rare diseases.
Patients can register for outpatient consultation on website: esveikata.lt
When arriving for consultation, you should have a referral to the specialist. You should bring your ID, and, if relevant, medical documents from other healthcare institutions, drugs and other items you may need during the day. Upon arrival, go to reception. You will need to provide a referral letter there and you will be directed to the physician‘s office.
If you have any questions, please write an e-mail to: firstname.lastname@example.org.
Coordinator of the competence center prof. Eligijus Poškus, tel. 85 236 5256 e-mail email@example.com.
Subcoordinator of the competence dr. Edita Baltruškevičienė tel. 85 278 6784, e-mail firstname.lastname@example.org.
Coordinating Centre for Rare Diseases
Santariškių 4, 08406 Vilnius, Lithuania
Tel. +370 656 46 622 (call Monday to Friday 13:00 – 15:00)