Wong EHC, et al. - This is the first report in English to report the long-term 5-year survival outcome of endoscopic endonasal nasopharyngectomy (EEN) conducted in advanced recurrent nasopharyngeal carcinoma (rNPC) patients and to determine any prognostic factors for survival of patients. All individuals who had EEN for advanced rNPC between January 2003 and December 2015 inclusive have been analyzed. All surgeries have been conducted in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. Twelve rNPC patients (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). Data reported that the 5-year overall survival was 50.0%, disease-free survival was 25.0% and the disease-specific survival was 58.3%. In patients with rT3 and rT4 recurrent NPC, EEN is a feasible treatment to improve survival with minimal morbidities. Nonetheless, it is recommended that more research be carried out with larger patient size. There were no significant operative complications and no independent prognostic factors were established for survival outcome.