Peaches are highly susceptible to rapid deterioration and bacterial infection during postharvest transportation and storage, leading to significant losses. In order to maintain peach fruit postharvest quality and extend its shelf life, it is critical to understand the physiological changes in postharvest fruit and implement effective postharvest technologies. This paper reviews the major postharvest physiological changes in peach fruit, including respiration, ethylene, hormones, texture, sugars, amino acids, phenolics, and volatiles, analyzes the major postharvest peach fruit diseases and their control techniques (covering brown rot, soft rot, and gray mold), and summarizes approaches to extend the storage life of peach fruit and maintain quality through physical, chemical, and biological preservation techniques. This review evaluates the advantages and disadvantages of postharvest peach fruit preservation techniques by analyzing postharvest physiological and nutritional quality, and suggests future research directions aimed at ensuring peach fruit safety and quality assurance.