ABSTRACT: Microalgal-bacterial symbiotic wastewater treatment systems (MBSWTSs) have received widespread attention due to their capacity to achieve high pollutant removal efficiency during wastewater treatment, with low energy consumption requirements, efficient carbon sequestration, and wastewater resource utilization. This paper provides an overview of the treatment performance and current research status of MBSWTSs, including a detailed summary of the mechanisms of nitrogen, phosphorus, and carbon removal by MBSWTSs and the interactions between bacteria and microalgae. In particular, this review focuses on the influence of operational parameters on the regulation of the symbiotic system, such as the microalgal:bacterial ratio, N:P ratio, external carbon source, dissolved oxygen concentration, aeration mode, and light availability. Among these factors, the microalgal:bacterial ratio, carbon source, and light availability have an important influence on microalgal-bacterial competition, as well as the trophic mode of the system, biomass production, and the capacity for the process to be practically applied on a large scale. MBSWTSs still have some challenging aspects that have hindered their development and application, such as the unknown mechanism of microalgal-bacterial co-metabolism, limited previous practical applications, algal contamination, and harvesting difficulties. To overcome these challenges, future research requires a multidisciplinary approach, incorporating life sciences, material science, and other disciplines. Comprehensive research should be conducted on the metabolic mechanisms of MBSWTSs, the optimization of process performance and waste resource utilization, providing a theoretical and practical foundation for the practical application of MBSWTSs.