Ethical review by medical journals plays a pivotal role in safeguarding the rights and welfare of research participants, ensuring scientific rigor, and upholding academic integrity. Conversely, exemptions from ethical review are strategically designed to reduce administrative burden on researchers, facilitate the lawful utilization of existing information data and biological samples, and accelerate scientific innovation and translational outcomes. Balancing these dual objectives requires clear guidelines and consistent implementation. This study investigates current practices regarding exemptions from ethical review in Chinese medical journals. We selected 23 medical journals of comprehensive surgery indexed in the China Science and Technology Journal Citation Reports (Core Edition, Natural Sciences Volume, 2024) as our research subjects. The latest issues published between February and March 2025 were systematically collected. Papers involving "human-related life sciences and medical research" (hereafter "human-related research") were retrospectively analyzed to identify studies potentially eligible for exemptions from ethical review according to national regulations. Using literature analysis and case study methodologies, we examined key information, including exemption categories, the presence and wording of ethical review statements, and approval numbers. Among the 473 total papers screened, 278 (58.8%) constituted "human-related research", of which 35 papers (12.6% of "human-related research") fell within recognized exemption from ethical review scopes. Reporting practices among these papers for exemptions from ethical review were highly inconsistent: 30 contained no ethical review statement whatsoever; three stated "not involving ethical review" without further justification; and only two provided both an exemption statement and an official ethics committee reference number. This discrepancy highlights a critical gap between policy intent and practical execution. Crucially, the authority to waive ethical review resides exclusively with institutional ethics committees, rather than authors or journal editors. However, our findings reveal that current labeling practices for exempted "human-related research" remain markedly non-standardized, with expressions lacking clarity or necessary contextual details and diverse categories distribution. Underlying causes include conceptual ambiguity regarding exemption criteria, insufficient explicit guidance from regulatory bodies, and inadequate enforcement mechanisms within editorial processes. To address these deficiencies, multi-faceted interventions are urgently needed. First, strengthened policy guidance from national health and scientific authorities must clarify exemption categories and mandatory reporting standards. Second, standardized process management protocols should be established, and journals are required to implement systematic checks for ethical compliance, even in exempt cases. Third, enhancing editorial capabilities through targeted training programs will empower editors to accurately identify, evaluate, and appropriately label exempted papers. These comprehensive measures can improve the standardization of ethical review annotations in medical journals, thereby reinforcing trust in medical research while supporting efficient scientific progress.