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Robert Picariello, a 57-year-old accountant from Hempstead, was otherwise healthy when he mysteriously became jaundiced last November. He went to get examined at ��ɫAV Langone Hospital—Long Island, where a team of endoscopy experts discovered an obstruction in his bile ducts and found that Picariello had extrahepatic cholangiocarcinoma, a very rare form of bile duct cancer. It arose from intraductal papillary neoplasm of the bile duct (IPNB) with high grade dysplasia, which is an incredibly type of precancerous tumor, hardly ever seen in the Western world. According to recent research incidence of IPNB is only 0.3 cases per 1,000,000 individuals. This type of cancer forms in the common bile duct, where the liver and gallbladder ducts join.

Thanks to the skilled endoscopy team, Picariello’s cancer was caught at the earliest stage possible. The tumor was only 4 millimeters in size, meaning that with swift intervention, he had much better chance at a favorable outcome. He received a stent and was referred to surgical oncologist Gary B. Deutsch, MD, chief of the at ��ɫAV Grossman Long Island School of Medicine and director of the Robotic Surgical Oncology Program at the Perlmutter Cancer Center at ��ɫAV Langone Hospital—Long Island.

After consulting with Picariello on this rare disease, Dr. Deutsch successfully performed a minimally invasive robotic Whipple procedure, also called a pancreaticoduodenectomy, on Picariello’s cancer, removing the tumor. He continues to work with his care team to monitor his progress.

“I knew I could trust my doctors. They explained everything to me and were spot-on about what I could expect, guiding me through every step,” said Picariello. “What I have is so rare, there’s not a lot of data on it, but I still consider myself lucky that it was caught so early, and I was able to get a team that was ready to help me.”

In addition to Dr. Deutsch, Picariello’s team consisted of gastroenterologists John Rizzo, MD, clinical assistant professor of medicine, and Jessica Widmer, DO, associate professor of medicine and chief of the Division of Gastroenterology at ��ɫAV Langone Hospital—Long Island, and medical oncologist Michael Shusterman, MD, assistant professor of medicine and associate program director of the Hematology and Oncology Fellowship at ��ɫAV Langone Hospital—Long Island. His wife, who is a nurse, and his two children were also instrumental in making his recovery smooth.

“Robert’s case reminds us why it is so important to pay attention to your body and any changes or symptoms you feel,” said Dr. Deutsch. “Because he came in, and thanks to our gastrointestinal and hepatopancreatobiliary specialists, who work seamlessly with the primary care team, we were able to catch this as early as possible and give Robert the best possible outcome.”

��ɫAV Langone Health has two high-volume Whipple programs—one in Manhattan and one on Long Island—making it one of the largest and most long-standing programs of its kind. Dr. Deutsch himself has more than 500 complex robotic and minimally invasive surgeries under his belt, consisting of innovative approaches to liver, pancreatic, bile duct, and gastrointestinal malignancies. He was one of the first surgeons to perform a robotic Whipple procedure in New York and part of the first surgical team to perform a robotic prophylactic bilateral mastectomy in the United States.

About ��ɫAV Langone Health

��ɫAV Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc., has ranked ��ɫAV Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. ��ɫAV Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and more than 300 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health.