This article aims to present the challenges, trends, and advancements in winery wastewater treatment systems through a systematic literature review. The methodology was based on the guidelines proposed by PRISMA. Initially, 293 articles published in the last decade were analyzed, and out of these, 122 were selected as relevant for the review. The average removal of chemical oxygen demand (COD) for each group of technology analyzed is as follows: 66% for physicochemical processes, 83% for biological processes, 90% for constructed wetlands (CWs), 96% for membranes, 42% for microbial fuel cells (MFCs), and 71% for advanced oxidation processes (AOPs). AOPs exhibit the highest efficiency in color removal (over 95%). Almost complete removals of total phenols are observed in AOPs and membrane systems. On the other hand, less robust systems such as biological sand filters and CWs also achieve removals of phenols exceeding 85%. Regarding nutrient removal, physicochemical processes show an average removal of 82% for phosphorus, while biological processes and CWs achieve removals exceeding 85% for total nitrogen. Adaptations of traditional technologies and emerging technologies show a trend towards eco-efficiency, with the reuse of residues in treatment systems (e.g., grape pomace as adsorbent), the recovery of compounds (e.g., polyphenols) and energy in the form of chemical (biogas in anaerobic systems) and electrical energy (MFCs). This literature review provides a compilation of quantitative and qualitative data to support decision-making related to winery wastewater treatment and presents possibilities to make this agro-industrial sector more sustainable.