Recent reports have shown that morbidity and mortality after gastrectomy for gastric cancer vary between authors, countries, and procedures. Common complications related to gastrectomy are postoperative bleeding, anastomotic leakage, pancreatic juice leakage, intra-abdominal abscess, intestinal obstruction, wound dehiscence, and so on. Recently, laparoscopic gastrectomy for gastric cancer has developed, especially in Japan and East Asian countries because it is less invasive. Several retrospective studies have shown that the operative complication rate is similar to that of conventional open surgery. Although most postoperative complications can be successfully treated by conservative therapies, surgical management is occasionally needed to prevent a fatal outcome. This review article provides insight into how surgeons can make efforts to reduce postoperative complications through proper preoperative evaluation and improved surgical skills during the initial gastrectomy. In addition, it reviews guidance for timely revisional surgery to allow salvage of patients with serious acute operative complications based on clinical findings made by a group of experienced surgeons.