Postoperative complications carry implications for short-term quality of life and negatively affect the cost of care. In addition, there is evidence that postoperative complications are associated with worse long-term oncologic outcomes.[1] While the exact mechanism of the impact on long-term survival is unclear, one factor is that postoperative complications result in delays in receiving chemotherapy after surgery and, in some cases, exclude the possibility for chemotherapy after surgery. Hendren et al. used the SEER-Medicare database to examine the risk for chemotherapy omission in colorectal cancer patients during the years 1993 through 2005.[2] They found that patients who suffered postoperative complications were more likely to have chemotherapy delayed or omitted.[2] Tevis et al. looked at this question in patients undergoing surgery for rectal cancer.[1] They found that patients with postoperative complications had worse long-term survival than patients with no complications. Using a multivariable analysis, postoperative complications correlated with decreased overall survival in patients who received chemotherapy. These results suggest that in addition to omission of chemotherapy, complications may have other negative effects leading to decreased long-term survival.[1] Some postoperative complications may be caused by spillage of cancer cells, delay in adjuvant therapy, and immunosuppression. As we have learned more about the colonic microbiome, some theorize that it may also be a component of the impact that occurs after an anastomotic leak.[3][4]