Abstract: There are 10%-36% of nasopharyngeal carcinoma patients suffering from local and/or regional recurrence after primary treatment. The efficacy of re-irradiation to recurrent NPC (rNPC) has been suboptimal. Moreover, the adjacent sensitive organs had already received a high dose of radiation, thus the re-irradiation could result in severe radiation-related complications. Surgery could remove the radiation-resistant lesion directly and avoid complications of re-irradiation, therefore, salvage surgery has been well established and become the first-line treatment for rNPC. Various open surgical approaches had been devised for nasopharyngectomy but presented many surgical complications. In recent decade, the endoscopic nasopharyngectomy (ENPG) had gained popularity for rT1-2 and selected rT3 patients with its minimal invasiveness and the resection range is similar to most open surgeries. Additionally, a new Surgical Staging System established to aid clinicians in choosing the most suitable treatment for rNPC patients. Nowadays, the utilization of extracranial/intracranial vascular bypass and internal carotid artery embolization is widening the indications of salvage surgery, while whether the extended resection exhibits better survival than re-irradiation needs further clinical evidence.