Perioperative Therapy for Resectable Pancreatic Cancer

Inclusion Criteria:

* Patients must have histologically or cytologically confirmed diagnosis of localized, resectable or borderline resectable, pancreatic adenocarcinoma T1-T3, N0-N1, M0; stage is determined by helical multi-phase computed tomography (CT) and/or endoscopic ultrasound according to published guidelines; resectability is determined by the treating surgeon and published guidelines (National Comprehensive Cancer Network)
* Resectable Disease- Head/Body/Tail of pancreas:

  * No distant metastases
  * Clear fat plane around celiac and superior mesenteric arteries (SMA)
  * Patent superior mesenteric vein (SMV) and portal vein (PV)
* Borderline Resectable Disease -Head/Body of pancreas:

  * Tumor abutment on SMA
  * SMV/portal vein impingement or occlusion if involving only a short segment, with open vein both proximally and distally (if proximal vein is occluded up to the portal vein branches then disease is unresectable)
  * Colon or mesocolon invasion
  * Gastroduodenal artery (GDA) encasement up to origin at hepatic artery
* Tail of pancreas:

  * Adrenal, colon or mesocolon, or kidney invasion
  * Preoperative evidence of biopsy-positive peripancreatic lymph node
* No prior therapy for pancreatic cancer
* Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (Karnofsky \>= 60%)
* Leucocytes \>= 3,000/uL
* Absolute Neutrophil Count \>= 1,500/uL
* Platelets \>= 100,000/uL
* Total Bilirubin:

  * If within normal limits (WNL) to =\< 2.0, the subject is eligible
  * If \> 2.0 - \< 6.0, subject is eligible IF they have a biliary stent and total bilirubin is decreasing
  * If \>= 6.0, subject is not eligible
* Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT)(serum glutamate pyruvic transaminase \[SGPT\]) =\< 2.5 X institutional upper limit of normal or =\< 1.5 X upper limit of normal (ULN) if alkaline phosphatase (Alk Phos) \> 2.5 X ULN or if the subject has a biliary stent and the liver function tests (LFTs) are decreasing the subject is eligible
* Creatinine clearance \>= 30%
* Negative pregnancy test for women of childbearing potential; women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
* Ability to swallow and retain oral medication
* Ability to understand and willingness to sign a written informed consent document

Exclusion Criteria:

* Patients may not be receiving any other investigational agents
* Histology other than adenocarcinoma
* Patients with permanently unresectable pancreatic adenocarcinoma as determined by the treating physician and published guidelines (National Comprehensive Cancer Network)
* Unresectable disease
* Head of pancreas:

  * Distant metastases (includes celiac and/or para-aortic)
  * SMA, celiac encasement
  * SMV/portal occlusion
  * Aortic, inferior vena cava (IVC) invasion or encasement
  * Invasion of SMV below transverse mesocolon
* Body of pancreas:

  * Distant metastases (includes celiac and/or para-aortic); at the discretion of the treating surgeon, body and tail lesions that have positive celiac and/or para-aortic nodes in close vicinity to the primary may be borderline rather than unresectable
  * SMA, celiac, hepatic encasement
  * SMV/portal extended occlusion
  * Aortic invasion
* Tail of pancreas:

  * Distant metastases (includes celiac and/or para-aortic)
  * SMA, celiac encasement
  * Rib, vertebral invasion
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to gemcitabine, docetaxel, capecitabine, oxaliplatin or other agents used in the study
* Patients who have received prior chemotherapy or radiotherapy for the diagnosis of pancreatic cancer
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* Inability to comply with study and/or follow-up procedures
* Pregnancy or lactation
* Human immunodeficiency virus (HIV)-positive patients receiving combination anti-retroviral therapy