"19. It is well established that this court is a court of review. In R v A&B[1999] 1 Cr App R (S) 52 Lord Bingham CJ made this clear at page 56: 'the Court of Appeal Criminal Division is a court of review; its function is to review sentences imposed by courts at first instance, not to conduct a sentencing exercise of its own from the beginning.' 20. There is no basis for departing from the principle so clearly expressed by Lord Bingham..." 15. Thus the court considers the material before the sentencing court and any fresh material properly admitted undersection 23 of the Criminal Appeal Act 1968 , by reference to the well-established principles thereunder. It considers whether the sentence was wrong in principle or manifestly excessive. It does not, in the light of something that has happened since sentence, consider whether an offender should be sentenced in an entirely new way because, for example, of what has happened in the penal system or because the offender has supplied fresh information long after the event. 16. That is not to say that this court will not entertain updated information about an offender, such as updated pre-sentence and prison reports on conduct in prison. It does this under the limited exception identified by Lord Thomas CJ in R v Rogers[2016] EWCA Crim 801 ;[2016] 2 Cr App R(S) 36 , a judgment delivered some 3 months after the judgment in Roberts. At [8] in Rogers, Lord Thomas referred in particular to the decision of Lord Judge CJ in R v Caines; R v Roberts[2006] EWCA Crim 2915 ;[2007] 1 WLR 1109 , at [44]: in short, post-sentence information, such as a positive response by a young offender to his custodial sentence may impact on and produce a reduction in sentence. 17. Here we have a situation where information about the offender is not being updated in the sense envisaged in Rogers, namely by way of building on or undermining what was seen below as matters material to the seriousness of the offending or by way of aggravating or mitigating factors. Rather what the applicant seeks is a wholesale revision of the sentencing exercise by reference to entirely separate events which occurred only after sentence and of which the Judge was wholly unaware. No application undersection 23 of the Criminal Appeal Act 1968 has been made, nor would one have succeeded. Amongst other things the new material could not afford a ground for allowing the appeal. 18. We recognise that, unlike the position in Roberts and ZTR, the events relied upon here took place very shortly after sentence. However, that makes no difference to the correct approach as a matter of principle. It is not for us to re-open and effectively restart the sentencing process on a completely fresh basis. 19. This is a result consistent with the case law that has considered the question of the impact of serious medical conditions on the sentencing process. It is well established that an offender's serious medical condition may enable a court, as an act of mercy, in the exceptional circumstances of a particular case, rather than by virtue of any general principle, to impose a lesser sentence than would otherwise be appropriate (see R v Stevenson; R v Minhas[2018] EWCA Crim 318 ;[2018] 2 Cr App R(S) 6 at [10], referring to R v Bernard[1997] 1 Cr App R(S) 135 . However, as can be seen from the discussion in Stevenson at [10] to [20], appellate interference on the basis of a significant deterioration in a medical condition may be appropriate if the condition was known at the date of sentencing. Although the general principle is that this Court will only interfere with a sentence if persuaded that it was wrong in principle or manifestly excessive in length at the time when it was passed, the case law shows that a more flexible approach may properly be taken in cases of significant deterioration in a known medical condition. Whilst the appellate court may have regard to such deterioration, the cases in which it would be appropriate to do so are nevertheless rare. In the case of serious and worsening ill health, the combination of what have been described as the "