Once a key factor behind Vietnam's successful Doi Moi (restoration) economic reforms, the rice-centered agriculture of the VMD is now confronted by the new pressure of climate change impacts, including the intensifying salinity intrusion (SI). The SI menace has partly triggered the delta-wide emergence of new adaptive livelihood models across the VMD, including the prawn rice rotational crop (PRRC) that is arguably the most prominent. Research on the SI-driving factors is rapidly increasing in numbers, yet little synthesis has been done. Likewise, several studies have investigated the economic benefits of PRRC; less emphasis has placed on environmental and societal aspects, hence the questionable sustainability. This study, therefore, contributes a composite literature review, targeting two SI-related aspects: (i) key factors driving the intensification of SI in recent years across the Mekong Delta, and (ii) current understanding of the sustainability of PRRC. Results from the first review assignment highlight the four key SI-driving factors: riverbed incision, land subsidence, upstream dams, and sea-level rise. Also remarked are the critical absence of studies addressing multiple drivers and the need for a decoupling model to quantify the relative importance of each factor to strategize the adaptive measures. For PRRC, we reveal that while economic benefits have been widely reported, potential negative impacts of this model related to environmental and social aspects are lacking. Therefore, while the lucrative prawn trade might financially benefit the farmers', the economic benefit is marred by the underlying negative environmental impacts and social inequalities, limiting overall sustainability. This study also provides a case study to notify the spatial-temporal trends of PRRC in the last three decades and evaluate the associated geographical and social factors. Kien Giang province was selected as the study site since it is the largest PRRCacross the VMD. The lessons from Kien Giang can also be applied to other transformative agricultural models in both Mekong Delta and other deltas worldwide.