We read the article by Morris et al (Gut: Epub ahead of print doi:10.1136/gut.2007.137877) with interest; we feel however that a number of important points need to be clarified by the authors.

There is nearly a 25% reduction in the abdominoperineal resection (APER) rate during the 6-year study period; downsizing and downstaging of the tumour following neoadjuvant chemoradiotherapy which technically enables an anterior resection (AR) to be performed may in part explain this reduction.

Further, although the median rectal cancer surgery workload was only 2.5 per year in England during the study period, it is likely that with reorganisation of colorectal cancer services that this has increased.

The type of surgical resection for rectal cancer is based on tumour characteristics, …