Perioperative Chemotherapy and Total Neoadjuvant Chemotherapy for Pancreatic Adenocarcinoma.

Systemic therapy is recommended for all patients with pancreatic cancer. The sequencing of chemotherapy prior to surgery results in more consistent delivery of intended therapy, allows for assessment of treatment response, identifies patients at risk of early metastatic progression, and is associated with improved pathologic outcomes. Current management and controversies, including the role of neoadjuvant chemotherapy for anatomically resectable disease, are discussed herein.