Machined surface integrity, a composite reflection of the geometric, physical, chemical, and mechanical properties of the machined surface layers, is dictated by the thermo-mechanics loads and material removal modes inherent to the cutting processes. This integrity directly governed the in-service performance and lifespan of engineered components. A thorough investigation into how conditioning strategies influenced surface integrity was therefore fundamental to realize high-integrity surfaces, and was critically important for optimizing the machining of difficult-to-cut metallic materials. This review began by categorizing the metrics of machined surface integrity for these materials based on three aspects: geometric features, microstructural evolution, and surface-layer mechanical properties, while also summarizing the approaches for developing predictive models. Subsequently, it elucidated research advancements in machined surface integrity conditioning strategies of difficult-to-cut metallic materials, critically comparing the distinct influence mechanisms of tool and process optimization, multi-energy field assisted machining, and workpiece pre-treatment on machined surface integrity. Finally, this paper explored the prediction accuracy of current models and the general applicability of conditioning strategies, offering an outlook on future research priorities.