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We thank Murphy et al for their interest in our paper and agree that encouragingly the overall rate of abdominoperineal excision (APE) use for England was 25.5% which is below the level of 30% recommended by several independent professional bodies.1 2 Furthermore, we demonstrated an encouraging decline in APE rates over the 7 year period of our study. Despite this average value, however, striking variations in practice were observed across the country (8.5–52.6% across Hospital Trusts) and, given the potential impact on outcomes these variations could have, we maintain they are worthy of further exploration. As, in the most extreme cases, rates of use of this procedure were significantly above the 30% level recommended by the professional bodies, we believe these variations should not be ignored. We accept it is entirely possible they may …
Competing interests: None.