We thank Mr Clarke for his interest in our paper and the important data from his unit demonstrating how tumour height influences the formation of permanent stomas. As we stated in the paper, we agree strongly with his assertion that a key determinant in the type of operation used will be the heights of the tumours. Unfortunately, no national data are currently available to enable us to incorporate this factor into our analyses but, given the potential impact of this variable on our results, we have sought to investigate this problem further.

The Royal College of Pathologists states that the distance of the tumour from the dentate line should be recorded as part of the minimum dataset reported for every abdominoperineal excision (APE) specimen. Free text histopathology reports are returned to the Northern …