Nab-paclitaxel and Gemcitabine Hydrochloride Followed by Radiation Therapy Before Surgery in Treating Patients With Pancreatic Cancer That Can Be Removed by Surgery

Inclusion Criteria

• •Subjects must have histologically or cytologically confirmed adenocarcinoma of the pancreas
• •Tumors must be localized (non-metastatic) and classified as borderline resectable according to Americas Hepato-Pancreato-Biliary Association (AHPBA)/Society of Surgical Oncology (SSO)/Society for Surgery of the Alimentary Tract (SSAT) consensus criteria or be clinically node-positive via computed tomography (CT) or endoscopic ultrasound
• •* AHPBA/SSO/SSAT criteria (any one of the following):
• •* Tumor-associated deformity of the SMV (superior mesenteric vein) or PV (portal vein)
• •* Abutment of the SMV or PV \>= 180 degrees
• •* Short-segment occlusion of the SMV or PV amenable to resection and venous reconstruction
• •* Short-segment involvement of the hepatic artery or its branches amenable to resection and reconstruction
• •* Abutment of the superior mesenteric artery (SMA) \< 180 degrees
• •Subjects must have measurable disease (by RECIST 1.1), defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as \>= 20 mm with conventional techniques or as \>= 10 mm with spiral CT scan
• •No prior therapy for pancreatic cancer, including chemotherapy, radiation therapy, definitive surgery or investigational therapy
• •Members of all races and ethnic groups will be included
• •Eastern Cooperative Oncology Group (ECOG) performance status =\< 1
• •Absolute neutrophil count \>= 1.5 K/cu mm
• •Platelets \>= 100 K/cu mm
• •Hemoglobin \>= 9.0 g/dL
• •Total bilirubin =\< 1.25 x upper limit of normal (ULN)
• •Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 2.5 x institutional upper limit of normal
• •Creatinine within normal institutional limits or creatinine clearance \>= 60 mL/min
• •No active prior malignancy within 3 years of registration (with the exception of non-melanoma skin cancer, in-situ cancers, or Rai stage 0 chronic lymphocytic leukemia \[CLL\]); if patient is disease free from a prior malignancy between 3-5 years, special consideration can be requested; in these cases, if the risk of recurrence at 5 years is less than 20%, and in the opinion of the investigator the prior malignancy will not affect the patient's outcome in light of newly diagnosed pancreatic cancer, the patient may be eligible; this will require principle investigator (PI) review and approval on a case by case basis, and approval will be documented in the medical record; all patients who have been disease free from a prior malignancy for at least 5 years will be eligible
• •No baseline peripheral sensory neuropathy \>= grade 2
• •Women of child-bearing potential and men must be willing to use adequate contraception during the entire study and for 8 weeks following completion of all chemotherapy on study; this includes hormonal or barrier method, or abstinence
• •Ability to understand and the willingness to sign a written informed consent document