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  1. E Morris1,
  2. P Quirke1,
  3. J Thomas1,
  4. L Fairley1,
  5. B Cottier2,
  6. D Forman1
  1. 1
    Cancer Epidemiology Group, NYCRIS, St James's University Hospital, Leeds, UK
  2. 2
    National Cancer Services Analysis Team, Clatterbridge Centre for Oncology, Bebington, Wirral, UK
  1. Dr E Morris, Cancer Epidemiology Group, NYCRIS, Level 6 Bexley Wing, St James's Institute of Oncology, St James's University Hospital, Leeds LS9 7TF, UK; eva.morris{at}nycris.leedsth.nhs.uk

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We thank Selvasekar et al for their comments on our paper and agree that the reduction of 25% in the use of abdominoperineal excision (APE) over the period of our study is to be welcomed. Whilst, as the authors suggest, an increase in the use of neoadjuvant chemoradiotherapy may account for some of this reduction we feel the cause will be multifactorial and will also include factors such as the increased use of magnetic resonance imaging, the formation and establishment of multi-disciplinary teams and the specialisation of surgeons. As we stated in the discussion to our paper we are keen to investigate the influence of neo-adjuvant treatments on surgical practice but, currently, oncological data are not available nationally to enable us to assess its impact. Several studies have shown that the use of short-course radiotherapy does not influence the frequency of use of APE1 2 but …

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