**8. Current guidelines**

Due to a lack of strong data based on phase 3 clinical trials, it is not possible to talk about a gold-standard treatment in the neoadjuvant setting for pancreatic cancer patients. Most of the groups support the idea to perform surgery as an upfront treatment in resectable patients followed by adjuvant chemotherapy.

Current ESMO guidelines support the use of FOLFIRINOX followed by chemoradiotherapy in borderline resectable patients as a main option in pancreas cancer [52]. Contrarily, ASCO guidelines indicate that there is no clear evidence to support one regimen over another, and physicians may offer therapy based on extrapolation from data derived from studies in the metastatic setting [53].

Pancreatic cancer patients with resectable or borderline resectable disease should always be discussed in a multidisciplinary team. Neoadjuvant treatment should always be considered to attempt an R0 resection; otherwise, the chance of cure in non-R0-resected patients and also due to the meaning of the diagnosis itself will be similar to metastatic patients. Multidisciplinary team should at least include a digestive oncological surgeon with expertise in pancreatic surgery, a medical oncologist, a radiologist with expertise in pancreas, a radiation oncologist, and a pathologist, given the disparity of opinions and the importance of treatment agreement looking forward the best chance to those patients.

At SLAGO 2015 (Latin American Gastro-Enterology Cancer Symposium) congress [54], a meeting held every 2 years in Latin America that focuses on digestive malignancies, specialists from different Latin American countries met to discuss about pancreatic cancer. Concerning borderline resectable pancreatic cancer patients, SLAGO's main recommendation is to consider FOLFIRINOX schedule as the best choice for neoadjuvant treatment; then after selected patients that do not have disease progression after chemotherapy could be considered for radiotherapy with capecitabine as radio-sensibilizer before surgery. For patients who have contraindication to receive FOLFIRINOX and in older than 76 years, neoadjuvant treatment with gemcitabine plus nab paclitaxel combination can be an option [55].
