Swine wastewater (SWW) is a mixture of organic matter, nutrients, pollutants, and heavy metals that can pose significant risks to the environment and human health if left untreated. Hence, it is crucial to adopt suitable treatment processes to ensure effluent quality and resource recovery. This paper provides an overview of the most commonly used SWW biological treatment technologies, including natural processes, aerobic, and anaerobic processes. The removal performance and mechanisms of each process in treating SWW are discussed in detail. Additionally, this paper analyzes the key factors that affect the operational performance, such as temperature, organic loading rate, heavy metals, salinity, and other inhibitors, and explores optimization strategies to enhance SWW treatment performance. Finally, considering the current concerns in treating SWW, this paper proposes future perspectives on SWW treatment. By presenting a comprehensive analysis, this paper can aid in the development and application of SWW treatment technologies in the future.