Primary gastric lymphoma is certainly one of the subjects where the surgeon's role has truly diminished in the last decades. The large number of complete remissions after Helicobacter pylori eradication and the good response to radiotherapy and chemotherapy have completely changed the management and prognosis of this uncommon disease. Early detection and accurate stage workup are essential for gastric lymphoma management. This includes endoscopy with mapping biopsies, histopathology with immunohistochemistry, Helicobacter pylori testing and endoscopic ultrasound for accurate gastric and nodal involvement. First line of treatment is Helicobacter pylori eradication, a positive response of the disease being expected within several months. Chemotherapy and radiotherapy are recommended in advanced stages or in case of non-response to first line treatment. Currently, the surgical approach is uncommon in the initial treatment strategy and is reserved only for acute complications like severe bleeding or perforation. Multidisciplinary management is very important in all malignancies including gastric neoplasia and especially in primary gastric lymphoma. Future perspectives might bring about new therapeutic targets and a personalized approach to every patient diagnosed.