This paper reviews recent advancements in the pipeline transport performance of paste backfill slurry in long-distance underground backfilling operations, with a primary focus on applications in metal mines. Key aspects, including flow performance, energy consumption during transport, and operational stability, are discussed in detail. Slurry concentration and rheological properties, including viscosity, yield stress, and flow behavior, as well as particle size distribution, are examined for their effects on transport efficiency. The relationship between these characteristics and pipeline resistance is also examined. Factors like pipeline orientation, configuration, diameter, length, elbow design, and elevation gradients are explored, demonstrating that careful design can optimize flow performance, reduce energy consumption, and minimize the risk of blockages and bursts. Additionally, the roles of commonly used additives, such as water reducers, foaming agents, antifreeze agents, and thickeners, are discussed in terms of their impact on slurry flowability, stability, and resistance losses. Optimal slurry regulation, strategic pipeline design, and effective additive utilization improve flow efficiency, extend service life, and reduce maintenance costs, thereby ensuring reliable backfill operations. Future research should focus on innovative pipeline designs, such as improving material selection and configuration to optimize flow stability and reduce energy consumption. Advanced additives, including thickeners and water reducers, could further enhance slurry flowability, reduce pipeline resistance, and improve system reliability.