Nasopharyngeal carcinoma is a malignant tumor that occurs in nasopharyngeal epithelial tissue. Radiotherapy plays an important role in its treatment, while surgery only plays an auxiliary role. However, radiotherapy has a certain failure rate and may bring about serious complications, which significantly affect the quality of life of patients. With the rapid development of endoscopic skull base surgery, many centers have begun to re-examine and actively explore the role of endoscopic surgery in the treatment of nasopharyngeal carcinoma. This article will summarize the role of surgery in the treatment of nasopharyngeal carcinoma from the following three aspects: surgical treatment of recurrent or residual nasopharyngeal carcinoma, surgical treatment of skull base radiation necrosis after radiotherapy, and endoscopic surgery for primary nasopharyngeal carcinoma try. It is also necessary to further improve multi-center, large-sample, and long-term follow-up clinical trials, based on evidence-based medical evidence, to promote the transformation of nasopharyngeal carcinoma treatment models.