Crown-of-thorns starfish (CoTs) outbreaks remain a major cause of coral mortality in the Indo-Pacific, contributing to widespread and accelerating degradation of coral reef environments. Coral reefs in the South China Sea also outbreak CoTs, but research on CoTs in our country is limited. In this study, we reviewed the advances in research on CoTs physiology and ecology, the ecological effects of CoTs outbreaks, and the measures used to manage such outbreaks. The main conclusions are as follows:1) Each CoTs female produces approximately half a million to two-hundred million eggs per year, indicating a high reproductive potential. Consequently, if an environmental change leads to a marginal increase in the survival rate during the growing period of CoTs, a substantial number of adults will recruit, and thus lead to a CoTs outbreak. 2) The CoTs outbreak threshold is defined as 1000-1500 starfish/km² in areas with more than 20% coral cover. Outbreaks usually persisted for 1-10 years, and the time gap between the start of two outbreaks ranged from 10 to 27 years. Outbreaks were most likely to end with population precipitous decline caused by the rapid transmission of disease. 3) Incidences of large-scale destruction (>90% coral mortality) of scleractinian corals by CoTs outbreaks occurred primarily within the southern and western Pacific, but not in the Indian Ocean or in the northern and eastern parts of the Pacific Ocean, which may be explained by the relative dominance of Acropora in the southern and western Pacific. Outbreaks also indirectly destroy coral reefs by changing the benthic composition of the reefs, increasing the abundance of soft coral and macroalgae, and reducing the fish and coral diversity. 4) Whereas the terrestrial run-off hypothesis and predator removal hypothesis are the most biologically probable among numerous hypothesized outbreak causes, so far no single hypothesis could account for all the outbreaks. 5) Measures to manage outbreaks of CoTs include improving the water quality in marine environment, increasing the extent of no-take marine protected areas, releasing the predators of CoTs larvae to coral reefs, and directly removing CoTs from coral reefs. Among these, removing CoTs is the most direct and effective measure. However, irrespective of the improvements in the efficiency of direct control of CoTs populations, these measures will possibly only provide temporary or short-term solutions for minimizing the effects of CoTs outbreaks on coral reefs. Therefore, further research will be required to understand the ultimate cause(s) of CoTs outbreaks, which will provide long-term or permanent solutions.