Turning a Major Revision Request Into an Accepted Manuscript: How to Respond to Reviewers' Comments

Requests for major revision generate more anxiety than almost any other editorial decision, in part because authors struggle to interpret what the journal is signaling. Some view major revision as near acceptance and rush to make changes, while others interpret it as a softened rejection and respond incompletely. Both approaches miss the central purpose of major revision. A request for major revision represents a conditional investment by editors and reviewers. The topic is relevant and the question appropriate for the journal, but the manuscript is not yet ready for publication. This editorial provides practical guidance on how authors should respond, emphasizing judgment over persistence. Key principles include reading reviews with distance, understanding the structural issues underlying reviewer comments, and avoiding a checklist mentality. The editorial highlights the importance of using the response-to-reviewers form correctly, making revisions easy to identify, and respecting the significant time reviewers devote to thoughtful critique. Guidance is provided on responding without defensiveness, prioritizing core concerns related to framing and contribution, and reassessing whether the manuscript truly advances the field or has become redundant. Situations in which authors may reasonably decline to pursue revision, as well as how to disagree productively with reviewers, are also addressed. Major revision is neither a promise nor a rejection. When approached as collaboration rather than negotiation, it often results in a manuscript that is clearer, stronger, and more valuable to practicing surgeons.