The stomach, gastroesophageal junction, and duodenum are organs of complex physiology and cell biology. Neoplastic disease of these organs is a difficult surgical challenge, and mortality rates from gastric, duodenal, and distal esophageal cancer remain high despite advances in surgical technique, perioperative care, and adjuvant therapy and more aggressive surgical approaches. True “cures” elude the surgeon all too frequently. Fortunately, our understanding of the genetics and molecular biology of upper gastrointestinal neoplasms is increasing dramatically and can now have a significant impact on the clinical management of these tumors as surgical therapies continue to improve. The care of patients with benign disease of these organs is also evolving as medical therapy and surgical technology improve to lessen the morbidity associated with peptic ulcer disease, reflux disease, and morbid obesity. This article reviews the most significant advances in surgical intervention of the stomach and duodenum published in the past year.