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Unacceptable variation in abdominoperineal excision rates for rectal cancer
  1. O Faiz1,
  2. J Smith2,
  3. S Clark3
  1. 1
    Kings College Hospital, Denmark Hill, London, UK
  2. 2
    West Middlesex Hospital, Isleworth, London, UK
  3. 3
    St Mark’s Hospital, Harrow, UK
  1. Dr O Faiz, Kings College Hospital, Denmark Hill, London SE5 9RS, UK; omarfaiz{at}

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We congratulate Morris and colleagues (Gut Published Online First 5 June 2008. doi:10.1136/gut.2007.137877) for their innovative methodological approach that combined cancer registry with Hospital Episode Statistics (HES) data. This represents an important template for future epidemiological research.

Certain assumptions that were made in this manuscript do, however, require further scrutiny. The reliability of the study data for potential quality-of-service distinction between colorectal units, as eschewed by the authors, requires validation. An important comparative study between the HES and Association of Coloproctology of Great Britain and Ireland (ACPGBI) databases is cited as supportive evidence for the accuracy of the HES dataset.1 Although the latter investigation demonstrated concordance between mortality outcomes on HES and ACPGBI datasets following major colorectal procedures at a national level, concordance …

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  • Competing interests: None.

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