We read with interest the article by Morris et al (Published Online First: 5 June 2008. doi 10.1136/gut.2007.137877).While these data demonstrate significant variation in abdominoperineal excision (APE) rates across both National Health Service (NHS) trusts and individual surgeons, it should be appreciated that the rates in England overall were comparable with those of specialist centres.1 Furthermore, these data indicate that in 2003 approximately 25.5% of rectal cancer patients underwent APE in England, whereas a similar study from the USA reported a 51.7% incidence of anorectal excision in …