The aims of this study were to contribute to the drawing up of guidelines for the therapeutic approach to primary gastric lymphoma and to identify the most effective sequence of treatment in the different stages of the disease. We conducted a retrospective analysis of the clinical data of 34 patients with primary gastric lymphoma admitted from 1993 to 2001 to the 4th General Surgery Department of the "Federico II" University in Naples. All the patients underwent surgical therapy and neoadjuvant or adjuvant chemotherapy. Patients were subdivided according to stage of disease, histological grade of malignancy and sequence of treatment. The 2- and 5-year overall survival rates were 94% and 68%., respectively. We observed a longer survival (81% at 5 years) in patients with IE-IIE stage disease (according to Mushoff's staging) than those with IIIE-IVE stages (56%). Patients with low and intermediate grade lymphoma (according to the working formulation) had a longer survival (83% and 71%, respectively) than patients with high-grade malignancies (55%). We noted that IE-IIE stage patients who underwent neoadjuvant chemotherapy and surgery survived longer (100%) than those in whom surgery preceded chemotherapy (66%), whereas IIIE-IVE stage patients in whom surgery was the first treatment survived longer (70%) than those in whom surgery followed chemotherapy (37%). On the basis of our experience, in patients with IE-IIE stages of disease chemotherapy should precede surgery while in patients with IIIE-IVE stages the inverse sequence is more effective in achieving longer survival rates.