In 2014, surgical management of complex digestive pathology requires a multimodal approach. The association of chemotherapy combined with surgery allows obtaining promising 5 years survival, particularly for borderline adenocarcinoma of the head of the pancreas or for liver metastasis. The incremental use of cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy provides a clear benefit in long-term survival for selected patients with primary or secondary peritoneal carcinomatosis. Finally, the use of Enhanced recovery pathways (ERAS) after surgery is now validated in colorectal surgery, and the preliminary results in hepato-biliary and pancreatic surgery are very promising. The implementation of ERAS provides a reduction in hospital stays, postoperative complications and costs, even in elderly patients.