Objective: To analyze the relationship between extramembranous invasion (ENE) status, pathological features and prognosis in rectal cancer patients with lymph node metastasis. Methods: A total of 100 patients with lymph node metastasis rectal cancer who underwent radical resection in our hospital from January 2020 to June 2024 were selected. The medical records of the patients were sorted out to analyze the relationship between ENE and pathological features and prognosis. Results: Through microscopic observation, 48 patients were ENE positive and 52 patients were ENE negative in 100 patients. The ENE positive tumor budding level, nerve invasion, T stage and N stage were higher than those in the ENE negative group (P＜0.05). After 30 months of follow-up, 33 of the 100 patients relapsed, and the disease-free survival rate of the ENE positive group was lower than that of the ENE negative group (P＜0.05). Conclusion: Patients with lymph node metastasis and positive extramural invasion of rectal cancer are more aggressive, which is an important factor affecting the prognosis of patients.