At the 2014 American Gastrointestinal Oncology Conference in San Francisco, Dr. Fields, MD, from Washington University in St. Louis, reports on a retrospective clinical study from 2000-2012 by the American Gastric Cancer Collaborative involving seven medical centers. Of the 850 patients evaluated for gastric adenocarcinoma surgery, surgical complications occurred 699 times, with 342 cases presenting with at least one post-surgical complication within 30 days of surgery. Among patients with gastric cancer without surgical complications versus those with surgical complications, the 5-year survival rates were 43% versus 27%, respectively, with statistically significant differences. Preoperative factors associated with the development of complications were: elderly patients, high risk factor for anesthesia assessment, and previous history of upper gastrointestinal bleeding or gastric surgery. Surgical characteristics including complexity of surgery, presence of extensive gastrectomy, placement of nutrition and drainage tubes, intraoperative blood transfusion, duration of surgery, and amount of intraoperative blood loss were associated with the occurrence of complications. The high tumor stage also reduces the survival rate. Intraoperative deaths were not included in the statistics. Patients were followed up for a median of 35 months. The mean survival time of patients with and without complications after gastric cancer surgery was 25 months: 45 months; and the 5-year recurrence-free survival rate was 23%: 40%, respectively, p<0.0001. A similar phenomenon was observed in other oncologic surgeries, where complications affected the prognosis in patients with pancreatic tumors receiving neoadjuvant chemotherapy, and in patients undergoing esophagogastric surgery, where the 3-year survival rate decreased by 17% in the presence of surgical complications. It is important for physicians to be aware of older, more advanced patients who progress and require complex surgery, as patients at high risk can be identified prior to surgery to minimize complications.