Background: nab-paclitaxel + gemcitabine is approved for the treatment of metastastic pancreatic cancer. So far, few studies have investigate this regimen in patients with nonmetastatic disease. Here we describe our experience of using gemcitabine and nab-paclitaxel as neoadjuvant. Methods: Patients with resectable, borderline resectable or locally advanced pancreatic cancer were treated with gemcitabine (1000mg/m2 days 1, 8 and 15) and nab-paclitaxel (125mg/m2 days 1, 8 and 15) as neoadjuvant treatment. Some patients were treated also with chemoradiotherapy after completion of chemotherapy treatment. Response were assessed by FDG-PET, CA199 levels and EUS-elastography. Results: 58 patients were included into the study and treated wit gemcitabine plus nab-paclitaxel. The median number of cycles were 3 (range 2-14). At diagnosis 15 patients presented with resectable disease, 16 with borderline tumors and 27 patients had locally advanced cancer. Twenty-four patients received treatment with chemo-radiotherapy after chemotherapy and 35patients (60%) underwent surgery (12 resectable, 8 borderline and 15 with locally advanced cancer). Poor pathological tumor response, defined by Ryan Grade Regression Tumor (GRT) grade 2 or 3, was found in 18 patients and 17 had good pathological response (GRT grade 0 or 1). Seventeen patients presented progression disease during neoadjuvant treatment and 6 patients were inoperable. Median overall survival (mOS) and progression free survival (PFS) was 16.6 months (m) and 8,8 m respectively for the entire population. In resected patients mOS and PFS were 17,4 and 13,8 m respectively. mOS was 30,6 m in patients with good pathological and 16,5 m in poor responding patients (p = 0.008). Likewise, PFS was 16,6 m in patients with good pathological response versus 8,9 m in poor responding patients (p = 0,019). In a multivariate analysis no treatment with chemoradiotherapy (p = 0.006) and good GRT (p = 0.006) impacts in overall survival. Conclusions: Neoadjuvant treatment with gemcitabine plus nab-paclitaxel improve PFS and OS in patients with non metastatic pancreas adenocarcinoma who undergo surgery and show a good pathological responding tumor.