For the few patients who have early (upfront or borderline resectable) disease at the time of diagnosis, treatment traditionally involved surgery followed by adjuvant chemotherapy; however, up to 30% of patients did not receive chemotherapy due to the morbidity associated with surgery. Low rates of adjuvant chemotherapy administration in combination with the success of neoadjuvant chemotherapy in the locally advanced setting led to an increased interest in neoadjuvant chemotherapy in patients with early (upfront or borderline resectable) disease. Whether this approach, is superior to the traditional upfront surgery in patients with early disease is contentious. Over the last ten years, many groups have attempted to answer this question through randomised controlled trials with conflicting results.