The present study aimed to evaluate the effectiveness and safety of various salvage treatments to treat locally recurrent nasopharyngeal carcinoma (IrNPC). A comprehensive search was conducted to gather relevant research publications on salvage treatment for IrNPC. Specifically, 2‐, 3‐, and 5‐year overall survival were the primary outcome. A total of 89 studies with 101 cohorts were collected. Endoscopic nasopharyngectomy was found to be associated with a significantly improved 5‐year OS compared with CRT (p = 0.027) and IMRT (p = 0.016). Moreover, based on recurrence T classification, the 2‐, 3‐, and 5‐year OS were similar across different treatments. Endoscopic nasopharyngectomy was associated with a significant reduction in treatment‐related complications (grade ≥ 3) compared with IMRT (p < 0.001) and open nasopharyngectomy (p = 0.028). Endoscopic nasopharyngectomy may provide comparable treatment outcomes to re‐irradiation, while offering a better safety profile for selective patients with resectable IrNPC.